title: Statement on pregnancy in pulmonary hypertension from the Pulmonary Vascular Research Institute.
abstract: Pregnancy outcomes in patients with pulmonary hypertension remain poor despite advanced therapies. Although consensus guidelines recommend against pregnancy in pulmonary hypertension, it may nonetheless occasionally occur. This guideline document sought to discuss the state of knowledge of pregnancy effects on pulmonary vascular disease and to define usual practice in avoidance of pregnancy and pregnancy management. This guideline is based on systematic review of peer-reviewed, published literature identified with MEDLINE. The strength of the literature was graded, and when it was inadequate to support high-level recommendations, consensus-based recommendations were formed according to prespecified criteria. There was no literature that met standards for high-level recommendations for pregnancy management in pulmonary hypertension. We drafted 38 consensus-based recommendations on pregnancy avoidance and management. Further, we identified the current state of knowledge on the effects of sex hormones during pregnancy on the pulmonary vasculature and right heart and suggested areas for future study. There is currently limited evidence-based knowledge about both the basic molecular effects of sex hormones and pregnancy on the pulmonary vasculature and the best practices in contraception and pregnancy management in pulmonary hypertension. We have drafted 38 consensus-based recommendations to guide clinicians in these challenging topics, but further research is needed in this area to define best practices and improve patient outcomes.
authors.affiliation: Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: Anna R
authors.initials: AR
authors.lastname: Hemnes
authors.affiliation: Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals National Health Service (NHS) Foundation Trust, Sheffield, United Kingdom.
authors.forename: David G
authors.initials: DG
authors.lastname: Kiely
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, and Harvard University Medical School, Boston, Massachusetts, USA.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Cockrill
authors.affiliation: Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Zeenat
authors.initials: Z
authors.lastname: Safdar
authors.affiliation: Department of Obstetrics and Gynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Wilson
authors.affiliation: Section of Pulmonary Diseases, King Fahad Specialist Hospital, Dammam, Saudi Arabia.
authors.forename: Manal
authors.initials: M
authors.lastname: Al Hazmi
authors.affiliation: Pulmonary, Critical Care and Sleep Division, Tufts Medical Center, Boston, Massachusetts, USA.
authors.forename: Ioana R
authors.initials: IR
authors.lastname: Preston
authors.affiliation: Institute of Cardiovascular and Medical Sciences, College of Medical and Veterinary Science, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Mandy R
authors.initials: MR
authors.lastname: MacLean
authors.affiliation: Division of Pulmonary, Allergy, Critical Care, Occupational and Sleep Medicine, Indiana University School of Medicine and Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, USA.
authors.forename: Tim
authors.initials: T
authors.lastname: Lahm