Pregnancy and Pulmonary Hypertension

Pregnancy is a physiological stress test characterized by tightly coordinated interorgan communication. Pulmonary arterial hypertension (PAH) in pregnancy can disrupt this adaptive network and precipitate maladaptive cardiopulmonary-placental dysfunction. The prevalence of PAH has increased over the past 30 years and disproportionately affects women of childbearing age. As treatment options have increased and specialized treatment centers for pulmonary hypertension and cardio-obstetrics have developed, maternal and neonatal outcomes in this population have improved. PAH nonetheless carries substantial risk for both the mother and fetus in pregnancy. We sought to provide an overview of physiology, evaluation, risk assessment, and management of pregnant patients with PAH. The review adds to existing literature with its focus on contemporary evidence, updating risk stratification and medical management given newer guidelines and treatment options, while also highlighting areas where uncertainty remains.