Department of Cardiology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, PR China.
Department of Gynecology and Obstetrics, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, PR China.
Hypertens Res. 2024 Sep;47(9):2561-2573. doi: 10.1038/s41440-024-01795-4. Epub 2024 Jul 16.
Pregnancy is normally contraindicated in pulmonary arterial hypertension (PAH). Thanks to medical advances, the prognosis for pregnancy in patients with PAH has improved. The aim of our study was to investigate pregnancy conditions and outcomes in patients with mild, moderate and severe PAH. We searched PubMed, Embase, CNKI, Wanfang and Weipu databases for studies published before May 2024. Data from 29 included studies from 1898 references were pooled and analyzed. We calculated the rates for each group as well as the risk ratio (RR) and 95% confidence interval (CI) between pairwise. There was no statistical difference in maternal and neonatal survival between the mild and moderate groups. Maternal survival in the mild, moderate and severe groups was 100.0%, 99.7% and 88.8%, respectively, and neonatal survival was 100.0%, 99.7% and 96.0%, respectively. The incidence of NYHA class III-IV, pregnancy loss, intensive care unit (ICU) admission, fetal growth restriction, and neonatal asphyxia was lowest in patients with mild PAH and highest in patients with severe PAH (P < 0.001). The incidence of vaginal deliveries and term pregnancies was highest in the mild group and lowest in the severe group (P < 0.001). In conclusion, pregnant women with mild PAH can safely deliver a newborn. Given similar survival rates but greater economic and medical burdens, caution is advised in the moderate group. Pregnancy in the severe group is considered contraindicated.
妊娠在肺动脉高压（PAH）中通常是禁忌的。由于医学的进步，PAH 患者的妊娠预后已经得到改善。我们的研究目的是调查轻度、中度和重度 PAH 患者的妊娠情况和结局。我们检索了 PubMed、Embase、CNKI、万方和维普数据库，以获取截至 2024 年 5 月之前发表的研究。从 1898 篇参考文献中纳入了 29 项研究的数据，并进行了汇总和分析。我们计算了每组的发生率，并计算了两两之间的风险比（RR）和 95%置信区间（CI）。轻度和中度组的母婴存活率没有统计学差异。轻度、中度和重度组的产妇存活率分别为 100.0%、99.7%和 88.8%，新生儿存活率分别为 100.0%、99.7%和 96.0%。NYHA 分级 III-IV、妊娠丢失、入住重症监护病房（ICU）、胎儿生长受限和新生儿窒息的发生率在轻度 PAH 患者中最低，在重度 PAH 患者中最高（P<0.001）。轻度组阴道分娩和足月妊娠的发生率最高，重度组最低（P<0.001）。总之，轻度 PAH 孕妇可以安全分娩新生儿。鉴于相似的存活率但更大的经济和医疗负担，中度组需要谨慎。重度组妊娠被认为是禁忌的。
