LAUSR

Background Pulmonary arterial hypertension(PAH) in pregnancy is a risk factor for maternal and infant death. Our study was to explore the characteristics and outcomes of pregnant women complicated with PAH during different pregnancies. Methods Clinical data were compared among women complicated with PAH in the first and second pregnancy between 2012 and 2018. Results A total of 156 patients with newly diagnosed PAH during pregnancy were enrolled. Among them, 108 (26.9 ± 3.5 years old) and 48 (30.8 ± 4.8 years old) were diagnosed PAH during their first and second pregnancy, respectively. And the incidence rates were 5.7‰ and 6.6‰ (p = 0.448). Pulmonary artery systolic pressure(sPAP)(55 ± 19 vs. 71 ± 27 mmHg, p = 0.001), NYHA functional class III-IV patients (10.2% vs. 35.4%, p < 0.001) and incidence of heart failure (5.6% vs. 18.8%, p = 0.01) were higher in the second pregnancy group than those in the first pregnancy group. Multivariate linear regression revealed that parity and time of symptom onset were independent factors of sPAP during pregnancy (p<0.001). Multivariate logistic regression revealed that sPAP (OR = 1.045, 95% CI, 1.021-1.069) was a risk factor for perinatal heart failure, with a cut-off value of 56 mmHg (Youden index 0.586, sensitivity 93%, specificity 65%). The cumulative death rate in the subsequent 48 months (IQR: 29 to 71) were 2.8% and 10.4% (p = 0.033) in the first and second pregnancy group, respectively. Conclusions Incidence of PAH in pregnancy tends to increase with increased parity. PAH identified in during the second pregnancy were associated with more severe disease and poorer long term outcomes.