A recent systematic review titled “Pregnancy and pulmonary arterial hypertension: A clinical conundrum,” highlights that pulmonary arterial hypertension (PAH) is an absolute contraindication for pregnant women.
Pulmonary arterial hypertension (PAH) is a rare condition that causes progressive increases in pulmonary arterial pressure and pulmonary vascular resistance, eventually leading to right ventricular failure and death. PAH affects mostly women, the majority of whom are of childbearing age. Due to the high maternal-fetal morbidity and mortality of pregnancy in PAH, the only guideline that exists is that it is absolutely contraindicated and can warrant early termination of the pregnancy.
Pregnancy in women with pulmonary vasculopathies is rare with an incidence estimated at 1.1 per 100,000 pregnancies. There are a number of physiological changes that occur during pregnancy within the pulmonary and cardiovascular systems that create an increased synergistic stress, further aggravating PAH, which may lead to maternal and fetal demise.
However, with advances in diagnostic modalities and a greater understanding of this disease, an increasing number of women are electing to continue with pregnancy.
In their review recently published in the journal Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health, Sonu Sahni from the Department of Pulmonary, Critical Care and Sleep Medicine in New York and colleagues, performed a MEDLINE/PubMed search to understand evidence concerning PAH and pregnancy. From 1979 to 2014, the authors identified six case studies, and observed that case management in cases of pregnancy with PAH differs in treatment measures. With regard to their own center approach, the authors explained that a multidisciplinary team usually manages high-risk cases. The care approach in such cases gives priority to providing pregnant women intravenous prostacyclin therapy. The therapeutic goal is centered on optimization of right ventricular preload and systolic function, reduction in pulmonary vascular resistance and maintenance of aortic root pressure to allow sufficient right coronary artery filling of the right ventricle.
In the review, the authors point out that all women that have signs and symptoms of PAH and that are of child bearing age should be diagnosed as early as possible and managed with a care management approach based on maternal–fetal safety.