Pregnancies in women with pulmonary hypertension remain challengeable: a single-center experience from East China

In this study, we aim to find out maternal and fetal outcomes in women with PH resulting from different causes and try to determine the risk factors related to adverse maternal and fetal outcomes. 684 women were included in the final analysis, who were mainly had pulmonary hypertension secondary to congenital heart disease (65.4%). Patients with idiopathic PH have the highest mortality (35.3%) and the lowest live birth rate (82.4%). Mortality is similar between moderate and severe PH women(5.3% vs 9.7%, P=0.17), but live birth rate is much lower in severe PH women (78.6% vs 89.9%, P＜0.01). The overall mortality was 2.8%, decreasing from 6.6% (4/61) in 2001~2005 to 1.7% (4/235) in 2016~2020 (P=0.10). Hypoxemia and vaginal birth are risk factors of maternal death both in the univariate analysis [OR 13.49(5.15-35.31), OR 4.16(1.52-11.42), respectively] and multivariate analysis [35.28 (1.42-878.75), 850.86 (5.67-127606.74), respectively]. General anesthesia is a risk factor in the univariate analysis [OR 12.07(3.72-39.15)] but with no significance in the multivariate analysis (P=0.16). We demonstrate a lower mortality rate than previously reported, although of no statistical difference among years in our center. In PH secondary to connective tissue disease and idiopathic PH, maternal mortality remains high. Maternal and fetal outcome are related to the etiology and the severity of PASP. Hypoxemia is a risk factor of maternal death while cesarean section seems to be a protective factor. The ideal choice of anesthesia remains uncertain. PH-targeted drugs cannot effectively decrease mortality rate. Thus, pregnancies remain challengeable in PH women.