Risk factors for perinatal cardiac complications in pregnancy with pulmonary hypertension

Objective: To analyze the risk factors for complications in pregnancy associated with pulmonary hypertension (PH) and to develop a logistic regression model to predict cardiac outcomes. Methods: A retrospective analysis was performed on 249 women with PH, who were followed at the Beijing Anzhen Hospital, Affiliated to the Capital Medical University, from January 2012 to March 2015. All pregnancies were recorded. Overall, 214 cases of pulmonary arterial hypertension were identified. Univariate analysis and multivariate analysis were performed to determine the risk factors occurring during or after pregnancy in women with PH. Ultimately, six independent risk factors for cardiac events were determined. Results: There were 70 cases of cardiac complications (28.1%) with PH, including 7 cases of maternal death (2.81%). Independent risk factors were rapid progression of symptoms [OR = 3.044, 95% CI (1.042-8.895), P < 0.05], brain natriuretic peptide (BNP) plasma levels >= 300pg/mL [OR= 5.543, 95% CI (1.403-21.896), P < 0.05], severe pulmonary hypertension (PAP >= 80mmHg, 1mmHg = 0.133 kPa) [OR = 6.769, 95% CI (2.748-16.677), P < 0.05], World Health Organization functional class (WHO-FC) III-IV [OR = 6.053, 95% CI (2.638-13.886), P < 0.05], PH pre-pregnancy [OR = 5.434, 95% CI (1.298-22.738), P < 0.05], and delivery >= 28 weeks gestation [OR = 10.876, 95% CI (3.957-29.893), P < 0.05]. Conclusions: Early advice on contraception for patients with PH, and the need for patients to undergo a comprehensive assessment of cardiac function pre-pregnancy are suggested from the results of the present study.