Previous studies have reported mortality rates of up to 56% associated with pregnancy in pulmonary arterial hypertension (PAH) but the management of this disease has changed considerably in recent years. We conducted a multinational, prospective registry to examine the contemporary outcome of pregnancies in patients with PAH. During a 3-year period, the 13 participating centres reported 26 pregnancies. Three women (12%) died and one (4%) developed right heart failure requiring urgent heart-lung transplantation. There were 8 abortions; 2 spontaneous and 6 induced. Sixteen pregnancies (62%) were successful, i.e. the women delivered healthy babies without complications. These women had well controlled PAH (pulmonary vascular resistance, PVR, 500 ± 352 dyn.s.cm-5); eight of them were long-term responders to calcium channel blockers. In contrast, the women who died or required transplantation had poorly controlled PAH (PVR, 1,667 ± 209 dyn.s.cm-5). Pregnancy remains associated with a substantial mortality rate in PAH. However, our results indicate that the outcome of pregnancies in PAH has improved, at least when PAH is well controlled and particularly in long-term responders to calcium channel blockers. These data must be confirmed by larger series before the general recommendation to avoid pregnancy in all patients with PAH is reconsidered.

Pregnancy outcomes in pulmonary arterial hypertension in the modern management era / Jaïs, X; Olsson, Km; Barbera, Ja; Blanco, I; Torbicki, A; Peacock, A; Vizza, Carmine Dario; Macdonald, P; Humbert, M; Hoeper, Mm. - In: EUROPEAN RESPIRATORY JOURNAL. - ISSN 0903-1936. - STAMPA. - (2012). [10.1183/09031936.00141211]

Pregnancy outcomes in pulmonary arterial hypertension in the modern management era.

VIZZA, Carmine Dario;
2012

Abstract

Previous studies have reported mortality rates of up to 56% associated with pregnancy in pulmonary arterial hypertension (PAH) but the management of this disease has changed considerably in recent years. We conducted a multinational, prospective registry to examine the contemporary outcome of pregnancies in patients with PAH. During a 3-year period, the 13 participating centres reported 26 pregnancies. Three women (12%) died and one (4%) developed right heart failure requiring urgent heart-lung transplantation. There were 8 abortions; 2 spontaneous and 6 induced. Sixteen pregnancies (62%) were successful, i.e. the women delivered healthy babies without complications. These women had well controlled PAH (pulmonary vascular resistance, PVR, 500 ± 352 dyn.s.cm-5); eight of them were long-term responders to calcium channel blockers. In contrast, the women who died or required transplantation had poorly controlled PAH (PVR, 1,667 ± 209 dyn.s.cm-5). Pregnancy remains associated with a substantial mortality rate in PAH. However, our results indicate that the outcome of pregnancies in PAH has improved, at least when PAH is well controlled and particularly in long-term responders to calcium channel blockers. These data must be confirmed by larger series before the general recommendation to avoid pregnancy in all patients with PAH is reconsidered.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11573/446796
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