肺高血压患者的怀孕:系统性审查和元分析与元回归
Mahmoud El Iskandarani1, Reshma Golamari2, Branco G M Bettinotti2
1Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT, USA.
Journal of thoracic disease
|August 14, 2025
概括
患有肺高血压 (PH) 的怀孕仍然具有高风险,特别是严重的PH,与增加的孕产妇死亡率和不良胎儿结果有关. 尽管情况有所改善,但对孕妇PH患者来说,仔细评估风险至关重要.
科学领域:
- 心脏病学 心脏病学
- 孕产妇和胎儿医学 孕产妇和胎儿医学
- 肺部医学 肺部医学
背景情况:
- 肺高血压 (PH) 患者的怀孕传统上具有较高的孕产妇和胎儿死亡风险.
- 多学科护理的进步导致PH妇女更成功的怀孕.
- 本综述评估了最近的结果,并确定了这一高风险产科人群中的风险因素.
研究的目的:
- 系统地审查和元分析近期肺高血压孕妇患者的结果.
- 在这个群体中确定与孕产妇和胎儿发病率和死亡率相关的特定风险因素.
主要方法:
- 对MEDLINE,EMBASE和Cochrane数据库进行了系统的搜索,以寻找有关怀孕和PH结果的研究.
- 随机效应模型用于计算事件率,置信区间和赔率比率.
- 利用后勤回归模型使用元回归分析来识别风险因素.
主要成果:
- 该研究包括51项研究,涉及4583名PH孕妇患者;产妇死亡率为7.6%,大多数死亡发生在分娩后.
- 严重的PH显著增加了孕产妇死亡率 (OR 5.57),较高的静脉缩动脉压 (sPAP) 和艾森门格综合征 (ES) 也与较高的死亡率有关.
- 与轻度/中度PH相比,严重的PH与更高的堕胎率 (OR 3.64),早产 (OR 2.52) 和较小的妊娠年龄 (OR 3.96) 相关.
结论:
- 孕妇PH患者的结果正在改善,但严重的PH仍然与高死亡率和不良胎儿结果有关.
- 这些发现支持在严重PH中怀孕的禁忌.
- 由于潜在的风险,对于轻度/中度PH患者来说,个性化风险讨论是必不可少的.
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