Effect of Multidisciplinary Team (MDT) Centered on Pregnant Women with Pulmonary Hypertension on Treatment and Outcomes of Pregnancy

Background: The importance of multidisciplinary team (MDT) centered on pregnant women with pulmonary hypertension (PH) has been highlighted. However, rare studies have explored the its effects on pregnancy outcomes. This study seeks to investigate whether and how the MDT has an effect on the treatment and outcomes of PH pregnant women. Methods A pre- and post-intervention study was conducted based on an interrupted time series design to compare the treatment and outcomes of patients with PH before (pre-MDT) and after (post-MDT) implementation of the MDT. PH was defined as pulmonary artery systolic pressure (sPAP) ≥ 40 mmHg measured by echocardiography or right heart catheterization and sPAP at 40–60mmHg and over 60mmHg was defined as mild and severe PH, respectively. All results were analyzed by T-tests, Chi square tests or Fisher exact test and two-sided p-value < 0.05 was set to be statistically significant. Results 149 pregnancies were found in 143 women with PH. Overall, 46 pregnancies were elective abortions, remaining 49 and 54 pregnancies completing delivery in the pre-MDT group and post-MDT group, respectively. Five (10.2%) mother and seven (8.6%) neonatal died in the former, while no maternal deaths but 1.9% neonatal death occurred in the latter. In subgroup analysis, maternal and fetal/neonatal complications were higher in patients with severe PH and New York Heart Association (NYHA) functional class III/IV and all maternal deaths occurred in class III/IV women. In pre-MDT and post-MDT groups, there were 8 and 22 pregnant women receiving the pulmonary-specific therapy and completing delivery, respectively. The percentage of heart failure and urgent cesarean of pre-MDT group was higher than the post-MDT group (30.6% vs. 12.9%, p = 0.02; 40.8% vs. 14.8%, p = 0.01, respectively). Conclusion Implementing the MDT decreased the rate of urgent cesarean section and heart failure in patients with PH and no maternal death occurred in the post-MDT group. Pregnant women with severe PH and NYHA FC III/IV might have poor prognosis, whereas the use of pulmonary-specific therapy might improve outcomes of pregnancy in PH.