How severity and classification of pulmonary hypertension affect pregnancy outcomes: a systematic review and timeline.
How severity and classification of pulmonary hypertension affect pregnancy outcomes: a systematic review and timeline.
- 2024
Women with pulmonary hypertension (PH) have increased mortality during pregnancy and the peripartum period. An increasing number of publications suggest improvements in maternal outcomes, so we conducted a systematic review focusing on disease severity and maternal survival. After screening 9097 potential studies from 1967 to 2021, we identified 66 relevant publications. Outcomes improved continuously over time and mortality fell from 11.6% in studies published before 2015 to 8.2% in studies published after 2015. Mortality was lower in patients with mild disease (0.8%) than in those with Eisenmenger syndrome (26.2%) or idiopathic pulmonary arterial hypertension (7.4-24.0%). One major drawback of the published studies is that they define severity using echocardiographic-estimated pulmonary artery pressures, without considering more contemporary parameters. This systematic review provides new insights for preconception counseling on pregnancy risks related to PH and suggests that PH classification and severity should be carefully considered in determining an individual's pregnancy-associated risk. Copyright © 2024 Elsevier Ltd. All rights reserved.
English
0959-289X
NIHMS1991338 [mid] PMC11227390 [pmc] S0959-289X(24)00051-7 [pii]
*Hypertension, Pulmonary
*Pregnancy Complications, Cardiovascular
*Pregnancy Outcome
*Severity of Illness Index
Female
Humans
Hypertension, Pulmonary/co [Complications]
Pregnancy--Curated
MedStar Union Memorial Hospital
Journal Article
Systematic Review
Women with pulmonary hypertension (PH) have increased mortality during pregnancy and the peripartum period. An increasing number of publications suggest improvements in maternal outcomes, so we conducted a systematic review focusing on disease severity and maternal survival. After screening 9097 potential studies from 1967 to 2021, we identified 66 relevant publications. Outcomes improved continuously over time and mortality fell from 11.6% in studies published before 2015 to 8.2% in studies published after 2015. Mortality was lower in patients with mild disease (0.8%) than in those with Eisenmenger syndrome (26.2%) or idiopathic pulmonary arterial hypertension (7.4-24.0%). One major drawback of the published studies is that they define severity using echocardiographic-estimated pulmonary artery pressures, without considering more contemporary parameters. This systematic review provides new insights for preconception counseling on pregnancy risks related to PH and suggests that PH classification and severity should be carefully considered in determining an individual's pregnancy-associated risk. Copyright © 2024 Elsevier Ltd. All rights reserved.
English
0959-289X
NIHMS1991338 [mid] PMC11227390 [pmc] S0959-289X(24)00051-7 [pii]
*Hypertension, Pulmonary
*Pregnancy Complications, Cardiovascular
*Pregnancy Outcome
*Severity of Illness Index
Female
Humans
Hypertension, Pulmonary/co [Complications]
Pregnancy--Curated
MedStar Union Memorial Hospital
Journal Article
Systematic Review