Analysis of pregnancy outcomes in puerperae with pulmonary arterial hypertension after congenital heart disease surgery

Xu Xiaohui; Zhang Dawei

doi:10.3760/j.issn.1673-4777.2026.06.019

Abstract：Objective To investigate the pregnancy outcomes of puerperae with pulmonary arterial hypertension(PAH)after congenital heart disease(CHD)surgery.Methods A retrospective cohort study was conducted on 83 puerperae with PAH after CHD surgery admitted to the Department of Obstetrics and Gynecology,Beijing Anzhen Hospital,Capital Medical University from June 2012 to June 2022.According to the systolic pulmonary artery pressure estimated by echocardiography,the patients were divided into mild-moderate PAH group(＜80 mmHg,66 cases)and severe PAH group(≥80 mmHg,17 cases).Differences in gestational week at delivery,mode of delivery,neonatal outcomes and adverse cardiovascular events were analyzed between groups.Patients were further divided into non-adverse cardiovascular event group(54 cases)and adverse cardiovascular event group(29 cases)based on the occurrence of adverse cardiovascular events during pregnancy and puerperium.Univariate and multivariate Logistic regression analyses were used to identify risk factors for adverse cardiovascular events during pregnancy and puerperium.Results All 66 patients with mild-moderate PAH terminated pregnancy in the third trimester(after 28 gestational weeks)under multidisciplinary management.Among 17 patients with severe PAH,2 underwent cesarean termination of pregnancy due to deteriorated cardiac function in the second trimester,and the rest delivered live births after 28 gestational weeks.The mean gestational week of all live births was(36.5±2.5)weeks,ranging from 31 to 40 weeks.Compared with the mild-moderate PAH group,the severe PAH group had earlier gestational week at delivery,lower neonatal birth weight,and higher incidences of preterm birth and adverse cardiovascular events(all P＜0.05).A total of 3 maternal deaths occurred,all in the severe PAH group,with PAH crisis as the main cause of death.Multivariate Logistic regression analysis showed that cardiac function grade Ⅲ-Ⅳ(odds ratio=3.156,95％confidence interval:1.419-7.017,P=0.005)and brain natriuretic peptide ≥ 100 ng/L(odds ratio=11.221,95％confidence interval:2.418-12.659,P＜0.001)were risk factors for adverse cardiovascular events during pregnancy and puerperium in patients with PAH after CHD surgery.Conclusions Standardized multidisciplinary management during pregnancy yields favorable pregnancy outcomes in patients with mild-moderate PAH after CHD surgery.Increased pulmonary artery pressure significantly raises the incidences of preterm birth,small-for-gestational-age infants and adverse cardiovascular events.Cardiac evaluation is recommended for patients with PAH after CHD surgery before pregnancy.