Pregnancy and pulmonary arterial hypertension—improving surveillance and outcomes with multidisciplinary care and N terminal pro-brain natriuretic peptide trends

Abstract

Objective

To describe maternal and fetal outcomes and N Terminal pro-brain natriuretic peptide (NT-proBNP) trends in pregnancy with pulmonary arterial hypertension (PAH).

Methods

The medical records of all pregnant women with PAH referred to Pulmonary Hypertension Clinic were retrospectively reviewed and analyzed.

Results

We identified 35 pregnancies in 22 women (mean age 27.9 ± 4.7 years, mean weight 50.6 ± 8.1 kg). The diagnoses were Eisenmenger syndrome (16, 72.7%), postoperative residual PAH (3, 13.6%), idiopathic PAH (2, 9.1%), and one (4.5%) had systemic lupus erythematosus. About 23 babies (65.7%) were born alive, gestational age of 35.1 ± 2.9 weeks, 47.8% at term, with a birth weight of 2.1 ± 0.8 kg. There was an elevation of NT-proBNP in the initial 72 h postdelivery (median 138 pg/ml, IQR 112-561). Those with a persistent rise beyond 72 h (median 686 pg/ml, IQR 370-3691) had prolonged recovery postpartum (median postdelivery hospital stay 18 days, IQR 12–22) reflecting continued right ventricular stress and maladaptation. There was single maternal mortality (4.5%).

Conclusions

Maternal and fetal outcomes of pregnancy associated with PAH are better with strict surveillance and multidisciplinary team effort. Postpartum period remains the most vulnerable time. NT-proBNP trends during this period may be a promising objective monitoring tool in identifying at-risk subsets thus improving outcomes.

Keywords:

• Pregnancy
• pulmonary hypertension
• brain natriuretic peptide
• outcomes
• Eisenmenger syndrome
• cardiac failure

Acknowledgments

We kindly acknowledge Dr Bindu Vijayakumar, Additional Professor, Department of Obstetrics and Gynecology, Government Medical College, Calicut, Kerala, India for her valuable suggestions. We acknowledge contribution of Mr. Abish Sudhakar, Medical data analyst, Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India for statistical analysis and figures.

Disclosure of interest

The authors have no conflicts of interest.