Pregnancy and pulmonary arterial hypertension—improving surveillance and outcomes with multidisciplinary care and N terminal pro-brain natriuretic peptide trends. (17th September 2022)

• Record Type: Journal Article
• Authors: Prasad, Cini Sudhakara; Kumar, Shine; Sumathy, Sudha; Kunjukutty, Radhamony; Puthenveettil, Nitu; Sen, Amitabh Chanchal; Sivabalakrishnan, Jeya Bawani; Kumar, Raman Krishna
• Is Part Of: Journal of maternal-fetal & neonatal medicine. Volume 35:Number 18(2022)
• Page Start: 3533
• Page End: 3539
• Publication Date: 2022-09-17
• Subjects: Pregnancy -- pulmonary hypertension -- brain natriuretic peptide -- outcomes -- Eisenmenger syndrome -- cardiac failure; Obstetrics -- Periodicals; Perinatology -- Periodicals; Infants (Newborn) -- Diseases -- Periodicals; Neonatology -- Periodicals; 618.2
• DOI: 10.1080/14767058.2020.1828333
• Languages: English
• ISSNs: 1476-7058

Abstract

Abstract: Objective: To describe maternal and fetal outcomes and N Terminal pro-brain natriuretic peptide (NT-proBNP) trends in pregnancy with pulmonary arterial hypertension (PAH). Methods: The medical records of all pregnant women with PAH referred to Pulmonary Hypertension Clinic were retrospectively reviewed and analyzed. Results: We identified 35 pregnancies in 22 women (mean age 27.9 ± 4.7 years, mean weight 50.6 ± 8.1 kg). The diagnoses were Eisenmenger syndrome (16, 72.7%), postoperative residual PAH (3, 13.6%), idiopathic PAH (2, 9.1%), and one (4.5%) had systemic lupus erythematosus. About 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 an elevation of NT-proBNP in the initial 72 h postdelivery (median 138 pg/ml, IQR 112-561). Those with a persistent rise beyond 72 h (median 686 pg/ml, IQR 370-3691) had prolonged recovery postpartum (median postdelivery hospital stay 18 days, IQR 12–22) reflecting continued right ventricular stress and maladaptation. There was single maternal mortality (4.5%). Conclusions: Maternal and fetal outcomes of pregnancy associated with PAH are better with strict surveillance and multidisciplinary team effort. Postpartum period remains the most vulnerable time. NT-proBNP trends during this period may be a promising objective monitoring tool in identifying at-risk subsets thus improving outcomes.