Maternal and fetal outcomes in pregnant women with pulmonary hypertension: The impact of left heart disease.
Maternal and fetal outcomes in pregnant women with pulmonary hypertension: The impact of left heart disease.
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肺动脉高压孕妇的母婴结局：左心疾病的影响。
DOI：
10.1016/j.ijcchd.2022.100354
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Rajpal,Saurabh
中科院分区：
文献类型：
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作者：
Marshall,WilliamH;Gee,Stephen;Lim,Woobeen;Lastinger,LaurenT;Cackovic,Michael;Benza,RaymondL;Daniels,CurtJ;Bradley,ElisaA;Rajpal,Saurabh
研究背景左心疾病所致的肺动脉高压（PH）（WHO第2组PH）是最大的PH亚组，然而大多数妊娠期PH的报道集中在肺动脉高压患者（WHO第1组PH）。我们评估了WHO PH亚组的妊娠结局。MethodsWe进行了一项回顾性单中心队列研究，研究PH孕妇的母儿结局。结果我们分析了70例PH患者的70例妊娠结局（30 ± 6岁），分类为WHO第1组PH（12例（17%））、第2组PH（45例（64%））、第3组PH（4例（6%））和第5组PH（9例（13%））。虽然没有发生围产期死亡，但3例（4.3%）WHO第2组PH妇女发生晚期死亡（产后7 ± 4个月）。此外，26名（37%）妇女发生了33起主要不良心脏事件，32名（49%）妇女发生了早产，10名（14%）妇女发生了产后出血，因此只有24名（37%）妇女完成了无不良心脏、产科或胎儿/新生儿事件的可行妊娠。主要不良心脏事件主要是由于心力衰竭（24例（73%）），仅发生在WHO第1组和第2组PH中（3例（25%）女性vs. 17例（38%），p = 0.07），并与先兆子痫、左心室射血分数≤ 45%、母体糖尿病、和全身性高血压。ConclusionsWHO第2组PH进行类似的风险，产妇心血管事件相比，WHO第1组PH的妇女。需要进一步研究评估这一队列中的孕产妇风险。
BackgroundPulmonary hypertension (PH) due to left heart disease (World Health Organization (WHO) Group 2 PH) is the largest PH subgroup, however most reports of PH in pregnancy focus on patients with pulmonary arterial hypertension (WHO Group 1 PH). We evaluated pregnancy outcomes across WHO PH subgroups.MethodsWe performed a retrospective single center cohort study of maternal and fetal outcomes in pregnant women with PH (2004–2018).ResultsWe analyzed outcomes of 70 pregnancies in 70 women with PH (30 ± 6 years-old), classified as WHO Group 1 PH (12 (17%)), Group 2 PH (45 (64%)), Group 3 PH (4 (6%)) and Group 5 PH (9 (13%)). Although no peripartum death occurred, 3 (4.3%) women with WHO Group 2 PH had late mortality (7 ± 4 months post-partum). Additionally, 33 major adverse cardiac events occurred in 26 (37%) women, preterm birth occurred in 32 (49%), and post-partum hemorrhage in 10 (14%), such that only 24 (37%) women completed a viable pregnancy free of an adverse cardiac, obstetric or fetal/neonatal event. Major adverse cardiac events were predominantly due to heart failure (24 (73%)), occurring only in WHO Groups 1 and 2 PH (3 (25%) women vs. 17 (38%), p = 0.07), and significantly associated with pre-eclampsia, left ventricular ejection fraction ≤45%, maternal diabetes, and systemic hypertension.ConclusionsWHO Group 2 PH carries similar risk for maternal cardiovascular events when compared to women with WHO Group 1 PH. Further studies evaluating maternal risk in this cohort are needed.