Pregnancy outcomes in pulmonary arterial hypertension in the modern management era
Pregnancy outcomes in pulmonary arterial hypertension in the modern management era
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DOI：
10.1183/09031936.00141211
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发表时间：
2012-10-01
影响因子：
24.3
通讯作者：
Hoeper, Marius M.
中科院分区：
文献类型：
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作者：
Jais, Xavier;Olsson, Karen M.;Hoeper, Marius M.
以前的研究报道了高达56%的死亡率与妊娠相关的肺动脉高压（PAH），但这种疾病的管理已发生了很大的变化，在最近几年，我们编制了一个多国，前瞻性登记研究，以检查妊娠PAH患者的当代结局。在3年的时间内，13个参与中心报告了26例妊娠。3例（12%）女性死亡，1例（4%）发生右心衰竭，需要紧急心肺移植。有8例流产; 2例自然流产，6例人工流产。16例（62%）妊娠成功，即女性分娩健康婴儿，无并发症。这些女性PAH控制良好（肺血管阻力（PVR）500 +/- 352 dyn.s.cm（-5））;其中8例对钙通道阻滞剂有长期反应。相反，死亡或需要移植的女性PAH控制不佳（PVR 1，667 +/- 209 dyn.s.cm（-5））。妊娠仍然与PAH的高死亡率相关。然而，我们的研究结果表明，PAH的妊娠结局有所改善，至少当PAH得到良好控制时，特别是在钙通道阻滞剂的长期反应者中。在重新考虑所有PAH患者避免妊娠的一般建议之前，必须通过更大系列证实这些数据。
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 compiled a multinational, prospective registry to examine the contemporary outcome of pregnancies in patients with PAH.During a 3-yr period, the 13 participating centres reported 26 pregnancies. Three (12%) females died and one (4%) developed right heart failure requiring urgent heart-lung transplantation. There were eight abortions; two spontaneous and six induced. 16 (62%) pregnancies were successful, i.e. the females delivered healthy babies without complications. These females 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 females 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 pregnancy 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.