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Semin Respir Crit Care Med 2017; 38(02): 148-159
DOI: 10.1055/s-0037-1602242
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pulmonary Hypertension in Pregnancy

Debasree Banerjee
1   Division of Pulmonary, Critical Care, and Sleep, Rhode Island Hospital, Providence, Rhode Island
2   Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
,
Corey E. Ventetuolo
1   Division of Pulmonary, Critical Care, and Sleep, Rhode Island Hospital, Providence, Rhode Island
2   Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
3   Health Services, Policy, and Practice, Brown University, Providence, Rhode Island
› Author Affiliations
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Publication History

Publication Date:
22 May 2017 (online)

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Abstract

Pulmonary arterial hypertension (PAH) is a pulmonary vasculopathy associated with abnormal cardiopulmonary hemodynamics and a limited life expectancy due to right heart failure. Young women are preferentially affected. Women with PAH are at increased risk of complications and death during pregnancy for both the mother and the fetus. While it is not well characterized how changes in sex steroids and other hormones during pregnancy affect pulmonary hypertension, many expected systemic and heart–lung physiologic adaptations during gestation are poorly tolerated in women with PAH. Despite the approval of numerous therapies for PAH in recent years, pregnancy avoidance or early termination is still recommended in women with PAH because of poor outcomes. In this review, we will discuss physiologic and hormonal changes in pregnancy as they relate to pulmonary vascular disease and right heart function. We will review current consensus recommendations and outline the management of pregnancy in PAH when it does occur.

Keywords

pulmonary hypertension - pregnancy - right heart failure