Background: Pregnancy associated with Pulmonary Arterial Hypertension (PAH) poses significant maternal and fetal mortality and morbidity risks. N terminal pro brain natriuretic peptide (NT-proBNP) trends are undescribed in this subset.
Aim: To describe maternal and fetal outcomes and NT-proBNP trends in pregnancy associated with PAH.
Materials and methods
We analysed prospectively collected data of maternal and fetal outcomes of pregnancy associated with PAH (2008 - 2019).
Results: We identified 35 pregnancies for 22 women (mean age 27.9 ± 4.7 years, mean weight 50.6 ± 8.1 kg). The diagnoses were Eisenmenger syndrome (ES) (16, 72.7%), post operative residual PAH (3, 13.5%), idiopathic pulmonary arterial hypertension (2, 9.2%) and one (4.5%) had systemic lupus erythematosus. 23 babies (65.7%) were born alive, gestational age of 35.1 ± 2.9 weeks, 47.8% at term, with a birth weight of 2.1 ± 0.8 kg. There was one neonatal death due to extreme prematurity, two still births, four medical termination of pregnancy and five abortions. Eighteen babies (78.2%) had low birth weight (LBW) and four (17.4%) had intrauterine growth retardation (IUGR). ES mothers had 60% premature delivery and 80% LBW babies. NT-proBNP levels were elevated in the initial 72 hours post delivery (median 138 pg/ml, range 64.5-955). A persistent rise beyond 72 hours (median 686 pg/ml, range 341-6680) was associated with prolonged recovery postpartum (median post delivery hospital stay 18 days, range 10-25) reflecting continued right ventricular (RV) stress and maladaptation. Overall mean hospital stay was 19 ± 9.8 days including mean intensive care unit stay of 4.8 ± 2.1 days with a single maternal mortality (4.5%).
Conclusions: Maternal and fetal outcomes of pregnancy associated with PAH are better but with concerning morbidity. Postpartum period remains the most vulnerable period. NT-proBNP trends may be useful to identify RV maladaptation and vulnerable subsets in postpartum period.