15 February 2020 by Shine Kumar

Pregnancy and pulmonary arterial hypertension - maternal and fetal outcomes and N terminal pro brain natriuretic peptide trends from a tertiary care centre with dedicated pulmonary hypertension clinic

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.

Key Contributors

Shine Kumar, Cini Sudhakara Prasad, Sudha Sumathi, Radhamony Kunjukutty, Nitu Puthenveettil, Amitabh Chanchal Sen, Jeya Bawani Sivabalakrishnan, Krishna Kumar Associate Professor, Dept. of Pediatric Cardiology, Assistant Professor, Dept. of Obstetrics and Gynecology, Professor, Dept of Obstetrics and Gynecology ,Professor and Head, Dept. of Obstetrics and Gynecology, Associate Professor, Dept of Anesthesia, Former Associate Professor, Dept of Anesthesia, Fellow, Dept of Pediatric Cardiology, Head, Dept of Pediatric Cardiology, AIMS, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

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