Pregnant Women with Pulmonary Arterial Hypertension Can Deliver Safely with Careful Management
Patient Care by Multidisciplinary Teams and Early Intervention are Imperative to Optimize Outcomes for Mother and Child
While women with pulmonary arterial hypertension (PAH) are discouraged from getting pregnant due to the high risk of morbidity and mortality for both mother and child, some patients with PAH still choose to become pregnant. According to a new study by New York Medical College (NYMC) faculty and students published in Cardiology in Review, these women can successfully bring a child to term with careful management by a team of physicians.
“Pregnancy sparks a series of physiological changes, including increased blood volume, heart rate, and cardiac output, and while these changes are necessary to support fetal development, they can exacerbate the already compromised cardiovascular function in PAH patients,” says Jodie Renaud, SOM Class of 2027, who lead authored the review alongside Saam Foroshani, SOM Class of 2025; William Frishman, M.D., professor of medicine and of pharmacology; and Wilbert Aronow, M.D., professor of medicine.
Citing a previous study, the NYMC researchers noted that right ventricular failure, cardiac arrest, pulmonary hypertensive crisis, preeclampsia, and sepsis were the primary causes of morbidity and mortality. That study also found that while the majority of pregnancies among PAH patients advanced past 20 weeks, 58 percent resulted in premature deliveries, most by cesarean section, and that 12 percent of pregnancies resulted in the mother’s death and three percent resulted in a stillbirth.
In their review, Renaud and her fellow researchers, advised that management of PAH during pregnancy should begin by making patients aware of the risks before they even decide to become pregnant, including the risk that PAH can worsen even after the pregnancy ends.
“For those who choose to continue with the pregnancy, meticulous planning and continuous monitoring are imperative,” says Renaud.
According to the review, patients should be cared for by a multidisciplinary team, including obstetricians, cardiologists, anesthesiologists, hematologists, and neonatologists. On the day of delivery, patients should be taken to the intensive care unit (ICU) for the insertion of a central venous catheter, and an arterial line to facilitate continuous monitoring, and additional monitoring in the ICU for several days after birth.
Ultimately, enhancing the understanding of PAH in the context of pregnancy will lead to better management strategies, reduced morbidity and mortality, and improved quality of life for affected women, the investigators concluded in the study.
