Balancing Risk and Hope: Insights Into Pregnancy Outcomes in Pulmonary Arterial Hypertension

Pregnancy poses substantial risks for women with Pulmonary Arterial Hypertension (PAH). This study aimed to evaluate maternal and neonatal outcomes in a contemporary PAH cohort under modern management, specifically investigating whether vasoreactive status warrants distinct clinical recommendations. We conducted a retrospective, longitudinal cohort study of PAH pregnancies managed at our institution between February 2010 and December 2023, comparing clinical characteristics, maternal complications, long-term outcomes, and neonatal parameters between vasoreactive and non-vasoreactive patients. Among 29 patients, 8 underwent pregnancy termination, and 21 proceeded with the pregnancy; 7 (33.3%) of whom were vasoreactive. Non-vasoreactive patients experienced significantly higher rates of major complications (35.7% vs. 0%, p = 0.039) and minor complications (92.9% vs. 0%, p < 0.001). Complications in the non-vasoreactive subgroup included prostacyclin initiation (78.6%), inotropic support (35.7%), mechanical circulatory support (14.3%), and one death (7.14%). All neonates born to non-vasoreactive patients were delivered preterm and showed a trend toward higher complication rates (84.6% vs. 42.9%, p = 0.054). Over a median 5-year follow-up, two non-vasoreactive patients died, whereas none of the vasoreactive patients lost their vasoreactive profile. In conclusion, despite advances in management, pregnancy in PAH remains associated with substantial maternal and neonatal morbidity. Vasoreactive patients, however, exhibit a distinctly favorable prognosis for both mother and offspring, which suggest the need for tailored recommendations for this subgroup.