Clinical outcomes of pulmonary hypertension in pregnancy among women with congenital heart disease in China

Figures & data

Figure 1. Workflow of the study participant. ES-PAH, pulmonary hypertension in Eisenmenger syndrome, PAH, pulmonary arterial hypertension, CHD-PAH, pulmonary arterial hypertension associated with congenital heart disease, PH, pulmonary hypertension, L-R-PAH, left to right shunt pulmonary arterial hypertension.

Table 1. Baseline characteristics of patients with PAH.

Maternal characteristics	Mild PAH	Moderate PAH	Severe PAH
Age of the patients (years)	29.29 ± 1.07	24.77 ± 0.82	25.23 ± 0.62
Obstetric history
Primigravida	12	24	50
Multigravida	5	3	1
Previous abortions	6	6	25
Cardiac corrective surgery	4	5	3
NYHA early to late in pregnancy
I	8/17***	7/27	4/51
II	8/17	15/27	21/51
III	1/17	4/27	17/51
IV	0/17	1/27	9/51**
Echocardiography
sPAP (mm Hg)	44.85 ± 1.37	54.2 ± 2.72	98.89 ± 3.95
pulmonary arterial diameter (mm)	24.33 ± 1.63	26.86 ± 1.59	31.32 ± 1.11
right ventricle diameter (mm)	39.25 ± 9.16	44.4 ± 3.79	42.27 ± 1.68
TRVmax(m/s)	3.01 ± 0.07	3.34 ± 0.11	4.57 ± 0.12

Data are presented as the number of subjects or mean value ± SEM, PAH: pulmonary arterial hypertension; NYHA: New York Heart Association; sPAP: systolic pulmonary artery pressure; TRVmax: Peak tricuspid regurgitation velocity.

Table 2. Patients’ characteristics of congenital heart disease.

Type of CHD	Number (%)	PAH
		Mild	Moderate	Severe
PAH in congenital heart disease (Group 1)
Eisenmenger’s syndrome	18	0	0	18
PAH in left-to-right shunts	60	11	21	28
PAH after defect correction	12	4	5	3
PH due to Valvular disease (Group 2)
Mitral stenosis + Aortic stenosis	1 (1.04%)	0	0	1
Mitral regurgitation	1 (1.04%)	1	0	0
Aortic stenosis	2(1.04%)	0	1	1
Other valve diseases	1	1	0	0
total	95(100%)	17	27	51

Data are presented as the number of subjects or the number (%) of subjects. PAH, pulmonary arterial hypertension.

Table 3. Summary of the mode of delivery in women with CHD-PAH.

Group	Case	Delivery
		Cesarean section	Vaginal delivery	Therapeutic abortion*
mild	17	12	2	3
moderate	26	21	2	3
severe	50	30	0	20
total	93	63	4	26

Data are presented as the number of subjects; 1 woman death before delivery in the moderate group, 1 woman check out from the hospital against medical advice in the severe group, *: Therapeutic abortion including vacuum aspiration, mid-trimester pregnancy medicinal abortion, abdominal hysterectomy.

Table 4. Summary of perinatal outcomes in CHD-PAH after surgically treated before pregnancy.

Group	Cases	Term birth	Birth weight ≤ 2500 g	Preterm birth	Iatrogenic abortion
Surgically treated	12	10(83.3%)	1(8.3%)	0(0%)	2(16.7%)
Surgically untreated	82	25(30.5%)	17(20.5%)	30(31.3%)	27(32.5%)
Total	94	35(37.2%)	18(18.9%)	30(31.6%)	29(30.5%)

Data are presented as the number of subjects or the number (%) of subjects; 1 woman death before delivery in the moderate group; 1 infant death before delivery in the severe group.

Figure 2. Pulmonary arterial pressure of CHD-PAH pregnant women. A. Pulmonary arterial pressure of the mild, moderate, and severe groups. Data represent means ± SEM. ***p < 0.001 compared with the severe group. B. Pulmonary arterial pressure of the surgically treated group and the surgically untreated group. A. Data represent means ± SEM. *p < 0.05 compared with the surgically untreated group.

Figure 3. Infant birth weight of CHD-PAH pregnant women. A. Infant birth weight of mild, moderate, and severe groups. Data represent means ± SEM. ***p < .001 compared with the mild group. B. Infant birth weight of the surgically treated group and the surgically untreated group. Data represent means ± SEM. *p < .05 compared with the surgically untreated group.

Table 5. Summary of perinatal outcomes in women with CHD-PAH.

Group	Cases	Term birth	Birth weight ≤ 2500 g	Preterm birth	Iatrogenic abortion
Mild	17	12(70.6%)	1(5.88%)	2(11.8%)	3(17.6%)
Moderate	26	17(65.4%)	7(26.9%)	5(19.2%)	4(15.4%)
Severe	50	15(30.0%)*	15(30.0%)	15(30.0%)*	20(40.0%)
Total	93	44(45.2%)	23(24.7%)	22(26.9%)	27(29.0%)

Data are presented as the number of subjects or the number (%) of subjects; 1 woman death before delivery in the moderate group. 1 infant death before delivery in the severe group, *p < 0.05 compared with the mild group.