Pregnant outcomes of critically ill pregnant patients with pulmonary hypertension: A multicenter retrospective study

Abstract

ObjectiveTo identify the pregnancy outcomes and risk factors of critically ill pulmonary hypertension (PH) patients with intensive care unit (ICU) admission.MethodsThe multicenter, retrospective cohort study was performed on 60,306 parturients from January 2013 to December 2018 in China. Diagnosis of PH was based on the estimation of systolic pulmonary arterial pressure (sPAP) via echocardiography. Patients were stratified by sPAP into three groups, mild (30–50 mmHg), moderate (51–70 mmHg), and severe (>70 mmHg). The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of in-hospital death, heart failure, and sustained arrhythmias requiring treatment. The secondary outcome was fetal adverse clinical events (FACE), a composite of fetal/neonatal death, prematurity, small birth weight, and fetal distress.ResultsA total of 181 pregnant patients were enrolled, including 101 patients with mild PH, 31 with moderate PH, and 49 with severe PH. The maternal median age was 32 (27, 35) years and 37% were nulliparous. The MACE occurred in 59 (59/181, 32.6%) women, including in-hospital death in 13 (13/181, 7.2%), heart failure in 53 (53/181, 29.3%), and sustained arrhythmias in 7 (7/181, 3.9%). The incidence of FACE was as high as 66.3% (120/181). Compared with mild and moderate PH patients, patients with severe PH had a significantly higher mortality rate (22.4 vs. 1.51%, P < 0.001) and MACE incidence (51.0 vs. 25.8%, P = 0.001). Although the incidence of FACE in severe PH was slightly higher than that in mild to moderate PH, there was no significant difference (69.4 vs. 65.1%, P = 0.724). PH complicated with left heart disease (OR = 4.365, CI: 1.306–14.591), elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) level (OR = 1.051, CI:1.015–1.088), and sPAP level estimated by echocardiography (OR = 1.021; CI: 1.003–1.040) were independently associated with MACE in multivariable regression (P < 0.05). Increased risk of FACE was noted for PH patients combined with eclampsia/preeclampsia (OR = 6.713; CI: 1.806–24.959).ConclusionThe incidence of MACE and FACE remained high in critically ill pregnant patients with PH, particularly moderate and severe PH in China. Further studies are warranted to identify subsets of women with PH at lower pregnant risks and seek more effective therapy to improve pregnancy outcomes.

Pregnancy feasibility in women with mild pulmonary arterial hypertension: a systematic review and meta-analysis

“…In addition,7093 records were excluded for irrelevant articles (n = 3310),case series reports (n = 1201),conference articles(n = 1314) and other inappropriate article type(n = 1268) by looking at the title and summary. Of the remaining records, 98 records were deleted for various reasons, the original reports could not be retrieved(n = 12), inappropriate exposure (n = 25),inappropriate study design (n = 32) and inappropriate outcome indicators(n = 29).Finally,32 studies [ 9 – 40 ] with 2520 patients met the inclusion criteria (Fig. 1 ).…”

“…Overall, 15 studies [ 11 – 22 , 38 – 40 ] were conducted, with 1,204 patients enrolled. Single-arm meta-analysis showed that the maternal mortality rates in the mild and moderate to severe groups were 0.15% (95%CI:0.00–0.93%) and 9% (95%CI:7–12%), respectively (Supplementary Fig.…”

“…Five studies [ 11 , 15 , 24 , 38 , 40 ] were conducted, with 553 patients enrolled. Single-arm meta-analysis showed that the incidence of low birth weight infants in the mild group and the moderate to the severe group was 18%(95%CI: 9–28%) and 34% (95%CI: 22–46%), respectively (Supplementary Fig.…”

“…Overall, 16 studies [ 11 – 13 , 15 – 17 , 19 , 22 , 24 , 26 , 27 , 29 , 30 , 32 , 39 , 40 ] were conducted, with 1,306 patients enrolled. The neonatal mortality rates in the mild group and the moderate to severe groups were 1% (95%CI: 0–1%) and 6% (95%CI: 3–15%), respectively (Supplementary Fig.…”

“…Data from 22 studies [ 9 , 12 – 19 , 22 – 24 , 26 – 28 , 31 , 32 , 34 , 36 – 40 ] with 1811 patients were included in the study. A single-arm meta-analysis showed that the cesarean section rates in the mild group and the moderate to severe groups were 80% (95%CI: 71–86%) and 79% (95%CI: 72–86%), respectively (Supplementary Fig.…”