Cardiovascular Complications with Delivery Hospitalizations in Patients with Pulmonary Hypertension: A Nationwide Study from 2011-2020

Background Pregnancy in patients with pulmonary hypertension (PH) is associated with heightened risk of various medical complications. Our study aims to understand the patient characteristics and investigate the association between PH and these complications in pregnant patients during delivery. Methods The National Inpatient Sample (NIS) was used to identify delivery hospitalizations from 2011 to 2020. The primary outcomes were in-hospital medical and obstetric complications. Multivariate logistic regression was performed to study the association of PH with these complications. Results A total of 37,482,207 delivery hospitalizations in women ≥18 years were identified from the NIS database out of which 9,593 patients had PH. Pregnant patients with PH had a higher incidence of complications during delivery including preeclampsia/eclampsia, cardiac arrhythmias, pulmonary edema amongst others, compared to pregnant patients without PH. Pregnant patients with PH had a higher incidence of in-hospital mortality compared to those without PH (0.51% vs 0.007%). In adjusted analyses, PH was independently associated with a higher risk of pulmonary edema (OR: 18.65 [95% CI: 13.71-25.38]), peripartum cardiomyopathy (14.06 [9.15-21.60]), venous thromboembolism (12.25 [7.80-19.24]), cardiac arrhythmias (11.75 [10.11-13.67]), acute kidney injury (7.53 [5.36-10.58]), preeclampsia/eclampsia (4.61 [4.04-5.25]), and acute coronary syndrome (2.83 [1.17-6.85]), compared with pregnant patients without PH. In-hospital mortality in patients with PH was associated with stroke (127.33 [78.49-206.57]), acute kidney injury (51.25 [34.40-76.36]), cardiac arrhythmias (24.80 [19.43-31.65]), peripartum cardiomyopathy (6.47 [3.23-12.97]), pulmonary edema (4.27 [2.18-8.37]), venous thromboembolism (2.75 [1.07-7.10]), and preeclampsia/eclampsia (1.87 [1.35-2.60]) compared to pregnant patients without PH. Conclusion Delivery hospitalizations in patients with PH are associated with high risk of various complications. Prenatal counseling and multidisciplinary care are essential to help mitigate unfavorable outcomes in these patients.