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Review
. 2022 Aug 11;9(8):260.
doi: 10.3390/jcdd9080260.

Pregnancy Considerations in the Multidisciplinary Care of Patients with Pulmonary Arterial Hypertension

Julie Coursen  1 , Catherine E Simpson  2 , Monica Mukherjee  3 , Arthur J Vaught  4 , Shelby Kutty  3 , Tala K Al-Talib  3 , Malissa J Wood  5 , Nandita S Scott  5 , Stephen C Mathai  2 , Garima Sharma  3
Affiliations
Review

Pregnancy Considerations in the Multidisciplinary Care of Patients with Pulmonary Arterial Hypertension

Julie Coursen et al. J Cardiovasc Dev Dis. .

Abstract

Pulmonary arterial hypertension (PAH) is a vasoconstrictive disease of the distal pulmonary vasculature resulting in adverse right heart remodeling. Pregnancy in PAH patients is associated with high maternal morbidity and mortality as well as neonatal and fetal complications. Pregnancy-associated changes in the cardiovascular, pulmonary, hormonal, and thrombotic systems challenge the complex PAH physiology. Due to the high risks, patients with PAH are currently counseled against pregnancy based on international consensus guidelines, but there are promising signs of improving outcomes, particularly for patients with mild disease. For patients who become pregnant, multidisciplinary care at a PAH specialist center is needed for peripartum monitoring, medication management, delivery, postpartum care, and complication management. Patients with PAH also require disease-specific counseling on contraception and breastfeeding. In this review, we detail the considerations for reproductive planning, pregnancy, and delivery for the multidisciplinary care of a patient with PAH.

Keywords: cardio-obstetrics; peripartum cardiovascular disease; pregnancy; pulmonary hypertension.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Classification of pulmonary hypertension. mPAP = mean pulmonary artery pressure. PVR = pulmonary vascular resistance. PAWP = pulmonary arterial wedge pressure. WU = Wood units.
Figure 2
Figure 2
Physiological changes during pregnancy.
Figure 3
Figure 3
Multidisciplinary cardio-obstetrics care team for pregnant patient with PAH. ECMO = extracorporeal membrane oxygenation. OB = obstetrics.
Figure 4
Figure 4
Postpartum changes in the patient with PAH. CCB = calcium channel blocker. PAH = pulmonary arterial hypertension. IVC = inferior vena cava. RV = right ventricle. VTE = venous thromboembolism.
See this image and copyright information in PMC

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