A new study has found an increased risk of adverse neonatal events in pregnant women with severe pulmonary arterial hypertension (PAH). The study, published in Pediatrics & Neonatology, compared birth outcomes in pregnant women with heart disease without PAH, with mild PAH, and with severe PAH.

“Current data as to whether neonatal outcomes in pregnant women with mild PAH are different from those in women with severe PAH are still scarce,” the authors wrote.

The research team conducted a retrospective study on 127 pregnant women with heart disease at a single center in China between April 2014 and December 2021. The participants were divided into 3 groups: no PAH (n=82), mild PAH (n=19), and severe PAH (n=26). All of the women completed a survey on maternal and perinatal characteristics and underwent echocardiography.

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Neonatal complications including preterm birth, low birth weight, small for gestational age, congenital heart defects, respiratory distress syndrome, necrotizing enterocolitis, intracranial hemorrhage, and neonatal asphyxia were recorded.

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The results revealed that the women with severe PAH were significantly more likely to have adverse neonatal outcomes, particularly premature birth, low birthweight, neonatal intensive care unit admission, and neonatal respiratory distress syndrome, among others.

However, the outcomes among women with mild PAH were more encouraging. Although their infants were also at a slightly higher risk of adverse events, long-term follow-up results were promising.

The authors caution that the small sample size limits the ability to draw firm conclusions. They recommend that women with severe PAH who wish to become pregnant are managed by a multidisciplinary team during and after their pregnancy to ensure better outcomes.


Ma J, Luo F, Yan L. Neonatal outcomes in pregnant women with pulmonary arterial hypertension associated with heart disease. Pediatr Neonatol. Published online January 25, 2023. doi:10.1016/j.pedneo.2022.11.008