Pregnancy Considerations in the Multidisciplinary Care of Patients with Pulmonary Arterial Hypertension

Overview

Journal J Cardiovasc Dev Dis

Specialty Cardiology & Vascular Diseases

Date 2022 Aug 25

PMID 36005424

Authors

Julie Coursen

Catherine E Simpson

Monica Mukherjee

Arthur J Vaught

Shelby Kutty

Tala K Al-Talib

Malissa J Wood

Nandita S Scott

Stephen C Mathai

Garima Sharma

Affiliations

Soon will be listed here.

Abstract

Pulmonary arterial hypertension (PAH) is a vasoconstrictive disease of the distal pulmonary vasculature resulting in adverse right heart remodeling. Pregnancy in PAH patients is associated with high maternal morbidity and mortality as well as neonatal and fetal complications. Pregnancy-associated changes in the cardiovascular, pulmonary, hormonal, and thrombotic systems challenge the complex PAH physiology. Due to the high risks, patients with PAH are currently counseled against pregnancy based on international consensus guidelines, but there are promising signs of improving outcomes, particularly for patients with mild disease. For patients who become pregnant, multidisciplinary care at a PAH specialist center is needed for peripartum monitoring, medication management, delivery, postpartum care, and complication management. Patients with PAH also require disease-specific counseling on contraception and breastfeeding. In this review, we detail the considerations for reproductive planning, pregnancy, and delivery for the multidisciplinary care of a patient with PAH.

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