Clinical study of postpartum cardiac indexes and cardiac function changes in pregnant women with pulmonary hypertension associated with congenital heart disease

Wu Linqin; Zhang Jun

doi:10.3760/j.issn.1673-4777.2025.04.017

Abstract：Objective To investigate the changes of cardiac indexes and cardiac function in pregnant women with pulmonary hypertension associated with congenital heart disease(CHD-PAH)during pregnancy and 6 months after delivery.Methods A total of 75 pregnant women with CHD-PAH who delivered in Beijing Anzhen Hospital,Capital Medical University from August 2018 to December 2022 were selected as the research objects.The pregnant women with CHD-PAH were grouped according to the results of prenatal echocardiography.According to pulmonary artery systolic pressure(SPAP),the patients were divided into mild group(41 cases),moderate group(22 cases)and severe group(12 cases).The pregnancy outcomes of the three groups were observed,and the changes of cardiac indexes and cardiac function during pregnancy and 6 months after delivery were analyzed.Results The gestational weeks of termination of pregnancy in the moderate group and the severe group were less than those in the mild group,the proportion of cesarean section and premature delivery were higher than those in the mild group,and the amount of postpartum hemorrhage in the severe group was more than that in the mild group(all P＜0.05).The birth weight of neonates in the severe group was lower than that in the mild group,the proportions of low birth weight infants in the moderate and severe groups was higher than that in the mild group,and the proportion of neonatal asphyxia in the severe group was higher than that in the mild group(all P＜0.05).The SPAP of the moderate and severe groups before pregnancy/early pregnancy,prenatal and 6 months after delivery were higher than those of the mild group(all P＜0.05),but there was no significant difference in SPAP among different time points within each group(all P＞0.05).There were no significant differences in left ventricular end-diastolic diameter,right atrial area and brain natriuretic peptide level among the three groups at each time point(all P＞0.05).The follow-up results showed that the cardiac function of 1 case in the moderate group and 4 cases in the severe group changed from grade Ⅲ-Ⅳ to grade Ⅰ-Ⅱ,and there was no significant difference in the proportion of grade Ⅰ-Ⅱ of cardiac function in the mild,moderate,and severe groups[100.0％(41/41),100.0％(22/22)and 91.7％(11/12)](P=0.70).The long-term follow-up proportion of cardiac function grade Ⅲ-Ⅳ in the severe group was lower than that in the prenatal period[91.7％(11/12)vs 41.7％(5/12)](P＜0.05).Conclusions The SPAP of pregnant women with severe CHD-PAH increases during pregnancy and decreases at 6 months after delivery,but it is still higher than the SPAP level of pregnancy/early pregnancy,and the cardiac function recovers well in long-term follow-up.The incidence of adverse maternal and fetal outcomes in pregnant women with severe CHD-PAH is high.The comprehensive use of cardiac diuretics,vasoactive agents and targeted drugs can effectively reduce the mortality of pregnant women with CHD-PAH,but patients with severe PAH are still contraindications to pregnancy,and it is recommended to avoid pregnancy.