Potnuru Paul P, Jefferies Hayden, Lei Roy, Igwe Paula, Liang Yafen
Department of Anesthesiology, Critical Care and Pain Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
Department of Anesthesiology, Critical Care and Pain Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
Pregnancy Hypertens. 2024 Dec;38:101170. doi: 10.1016/j.preghy.2024.101170. Epub 2024 Nov 18.
Maternal pulmonary hypertension can pose substantial morbidity and mortality risks, particularly during labor and delivery. Although maternal pulmonary hypertension is conventionally considered a contraindication to pregnancy, advances in the management of pH may contribute to improving outcomes.
In this nationwide study, we aim to characterize the prevalence of maternal pulmonary hypertension in the United States and its association with adverse cardiopulmonary outcomes during delivery hospitalizations.
In this cross-sectional cohort study, we analyzed delivery hospitalizations in the National Inpatient Sample from 2016 to 2020. The primary exposure was maternal pulmonary hypertension. The primary outcome was a composite of maternal cardiopulmonary morbidity events during the delivery hospitalization including: death, heart failure, intraoperative heart failure, pulmonary edema, cardiac arrest, myocardial infarction, ventricular fibrillation, respiratory failure, pneumonia, acute kidney injury, and cardiac conversion. Propensity score matching was used to estimate the association between maternal pulmonary hypertension and adverse cardiopulmonary outcomes, adjusting for sociodemographic variables and validated clinical comorbidities as covariates. Secondary outcomes included mechanical circulatory support utilization, length of stay, and total hospitalization costs.
Among 18,161,315 delivery hospitalizations, 4,630 patients had pulmonary hypertension, yielding a maternal pulmonary hypertension prevalence of 25 per 100,000 delivery hospitalizations with a yearly trend of increasing prevalence (odds ratio = 1.06, 95 % CI 1.01 to 1.11, P = 0.028). After propensity score matching to create well-balanced groups, 4,560 patients with pulmonary hypertension were compared to 4,560 patients without pulmonary hypertension. In this confounder-adjusted analysis, the primary composite outcome of cardiopulmonary morbidity and mortality occurred in 41.1 % of the PH group compared to 14.4 % in the no PH group (adjusted odds ratio = 4.16, 95 % CI 3.32 to 5.23, P < 0.001). Additionally, patients with PH had a higher incidence of mechanical circulatory support use (adjusted odds ratio = 9.08, 95 % CI 1.14 to 71.81, P = 0.037), longer length of stay (length of stay ratio = 2.82, 95 % CI 2.74 to 2.9, P < 0.001) and higher total hospitalization costs (total cost ratio = 1.67, 95 % CI 1.52 to 1.85, P < 0.001).
Maternal pulmonary hypertension is increasing in prevalence and is strongly associated with adverse cardiopulmonary outcomes in the United States, with 41.1% of pH patients experiencing a composite outcome of cardiopulmonary morbidity and mortality during delivery hospitalization. Our findings emphasize the importance of caring for patients with maternal pulmonary hypertension in a multidisciplinary setting at high-acuity centers to ensure appropriate management of cardiopulmonary complications that arise during labor and delivery.
孕产妇肺动脉高压可带来严重的发病和死亡风险，尤其是在分娩期间。虽然孕产妇肺动脉高压传统上被视为妊娠禁忌证，但肺动脉高压管理方面的进展可能有助于改善结局。
在这项全国性研究中，我们旨在描述美国孕产妇肺动脉高压的患病率及其与分娩住院期间不良心肺结局的关联。
在这项横断面队列研究中，我们分析了2016年至2020年全国住院患者样本中的分娩住院情况。主要暴露因素是孕产妇肺动脉高压。主要结局是分娩住院期间孕产妇心肺发病事件的综合指标，包括：死亡、心力衰竭、术中心力衰竭、肺水肿、心脏骤停、心肌梗死、心室颤动、呼吸衰竭、肺炎、急性肾损伤和心脏转复。倾向评分匹配用于估计孕产妇肺动脉高压与不良心肺结局之间的关联，并将社会人口统计学变量和经过验证的临床合并症作为协变量进行调整。次要结局包括机械循环支持的使用、住院时间和总住院费用。
在18161315例分娩住院病例中，有4630例患者患有肺动脉高压，孕产妇肺动脉高压患病率为每100000例分娩住院病例中有25例，且患病率呈逐年上升趋势（优势比=1.06，95%可信区间1.01至1.11，P=0.028）。在进行倾向评分匹配以创建均衡组后，将4560例患有肺动脉高压的患者与4560例无肺动脉高压的患者进行比较。在这项经过混杂因素调整的分析中，肺动脉高压组发生心肺发病和死亡的主要综合结局的比例为41.1%，而无肺动脉高压组为14.4%（调整后优势比=4.16，95%可信区间3.32至5.23，P<0.001）。此外，肺动脉高压患者使用机械循环支持的发生率更高（调整后优势比=9.08，95%可信区间1.14至71.81，P=0.037），住院时间更长（住院时间比=2.82，95%可信区间2.74至2.9，P<0.001），总住院费用更高（总费用比=1.67，95%可信区间1.52至1.85，P<0.001）。
在美国，孕产妇肺动脉高压的患病率正在上升，并且与不良心肺结局密切相关，41.1%的肺动脉高压患者在分娩住院期间经历了心肺发病和死亡的综合结局。我们的研究结果强调了在高 acuity 中心的多学科环境中护理孕产妇肺动脉高压患者的重要性，以确保对分娩期间出现的心肺并发症进行适当管理。
