Liu Yang, Li Yanna, Zhang Jun, Zhang Dawei, Li Jiachen, Zhao Yichen, Liu Kemin, Ma Xiaolong, Bai Chen, Gu Hong, Fan Xiangming, Wang Jiangang
Department of Pediatric Cardiac Center Beijing Anzhen Hospital Affiliated to Capital Medical University Chaoyang District Beijing China.
Department of Obstetrics and Gynecology Beijing Anzhen Hospital Affiliated to Capital Medical University Chaoyang District Beijing China.
Pulm Circ. 2022 Apr 22;12(2):e12079. doi: 10.1002/pul2.12079. eCollection 2022 Apr.
As pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) may increase maternal and fetal risk, this study explored the pregnancy outcomes of Chinese women with PAH-CHD. The clinical data of pregnant women with PAH-CHD admitted to the Beijing Anzhen Hospital from 2010 to 2019 were retrospectively analyzed; these patients and their offspring were followed up, with a mean period of 5.9 ± 2.7 years. Overall, 260 patients with PAH-CHD were included. The mean maternal age was 27.7 ± 4.1 years, and 205 (78.8%) patients were nulliparous. The estimated systolic pulmonary artery pressure was 40-50 mmHg in 34.6% of the patients, 50-70 mmHg in 23.1%, and >70 mmHg in 42.3%. More than 96% of patients were diagnosed with PAH-CHD before pregnancy. During pregnancy, heart failure occurred in 19.2% of the patients. Cesarean delivery was performed in 88.1% (15.0% emergency) of the patients. Complications included fetal distress (5.8%), preterm delivery (34.2%), and low birth weight (33.8%). A total of 15 mothers (5.8%) died, with the highest mortality rate in those with Eisenmenger syndrome (10/43, 23.3%), and 10 offspring died (3.8%), two (0.8%) following hospital discharge and eight (3.1%) while in hospital. Although most pregnant women with PAH-CHD were able to have children, PAH increased the maternal and fetal risk. Thus, an individualized risk-based approach with shared decision-making may be more appropriate in pregnant women with PAH-CHD.
由于先天性心脏病相关的肺动脉高压（PAH-CHD）可能会增加孕产妇和胎儿的风险，本研究探讨了患有PAH-CHD的中国女性的妊娠结局。对2010年至2019年入住北京安贞医院的PAH-CHD孕妇的临床资料进行回顾性分析；对这些患者及其后代进行随访，平均随访时间为5.9±2.7年。总共纳入了260例PAH-CHD患者。孕产妇平均年龄为27.7±4.1岁，205例（78.8%）患者为初产妇。34.6%的患者估计收缩期肺动脉压为40-50 mmHg，23.1%为50-70 mmHg，42.3%大于70 mmHg。超过96%的患者在怀孕前被诊断为PAH-CHD。孕期19.2%的患者发生心力衰竭。88.1%（15.0%为急诊）的患者进行了剖宫产。并发症包括胎儿窘迫（5.8%）、早产（34.2%）和低出生体重（33.8%）。共有15名母亲（5.8%）死亡，艾森曼格综合征患者的死亡率最高（10/43，23.3%），10名后代死亡（3.8%），其中2名（0.8%）在出院后死亡，另外8名（3.1%）在住院期间死亡。尽管大多数患有PAH-CHD的孕妇能够生育，但PAH增加了孕产妇和胎儿的风险。因此，对于患有PAH-CHD的孕妇，采用基于风险的个体化方法并共同决策可能更为合适。
