In this study, we aim to find out maternal and fetal outcomes in women with PH resulting from different causes and try to determine the risk factors related to adverse maternal and fetal outcomes. 684 women were included in the final analysis, who were mainly had pulmonary hypertension secondary to congenital heart disease (65.4%). Patients with idiopathic PH have the highest mortality (35.3%) and the lowest live birth rate (82.4%). Mortality is similar between moderate and severe PH women(5.3% vs 9.7%, P=0.17), but live birth rate is much lower in severe PH women (78.6% vs 89.9%, P＜0.01). The overall mortality was 2.8%, decreasing from 6.6% (4/61) in 2001~2005 to 1.7% (4/235) in 2016~2020 (P=0.10). Hypoxemia and vaginal birth are risk factors of maternal death both in the univariate analysis [OR 13.49(5.15-35.31), OR 4.16(1.52-11.42), respectively] and multivariate analysis [35.28 (1.42-878.75), 850.86 (5.67-127606.74), respectively]. General anesthesia is a risk factor in the univariate analysis [OR 12.07(3.72-39.15)] but with no significance in the multivariate analysis (P=0.16). We demonstrate a lower mortality rate than previously reported, although of no statistical difference among years in our center. In PH secondary to connective tissue disease and idiopathic PH, maternal mortality remains high. Maternal and fetal outcome are related to the etiology and the severity of PASP. Hypoxemia is a risk factor of maternal death while cesarean section seems to be a protective factor. The ideal choice of anesthesia remains uncertain. PH-targeted drugs cannot effectively decrease mortality rate. Thus, pregnancies remain challengeable in PH women.

In this study, we aim to find out maternal and fetal outcomes in women with PH resulting from different causes and try to determine the risk factors related to adverse maternal and fetal outcomes. We extracted the data from the records: the demographic information, onset, course, clinical and echocardiographic details, maternal and fetal complications, management as well as obstetric data, which included complications, infant of low-birth weight. We compared the outcome based on the cause of disease and pulmonary hypertension pressure levels. 603 women were included in the final analysis, who were mainly had pulmonary hypertension secondary to congenital heart disease (66.0%) and 46 of whom had Eisenmenger syndrome (7.6%). The mortality was 3.0%, 56% of which was caused by Eisenmenger syndrome. The abortion rate was 8.3% and 32% of live newborns were born before term. Heart failure complicated 17.1% and fetal growth restriction 3.5% of pregnancies. Advanced medication was administered in an increasing number of patients. Morbidity was significantly increased in women with pulmonary hypertension associated with a pulmonary hypertension pressure ≥80 mmHg. The mortality rate was lower than previously reported. Nevertheless, in Eisenmenger syndrome, PH secondary to connective tissue disease and idiopathic PH, the maternal mortality is still very high. In addition to the use of PAH-targeted drugs, we believe that standardized maternal management strategies can also help reduce mortality, including screening for heart disease and effective transport of critically ill patients. The maternal and infant outcome is related to etiology and the severity of PASP.