Cardiovascular Complications With Delivery Hospitalizations in Patients With Pulmonary Hypertension: A Nationwide Study From 2011 to 2020

Background Pregnancy in patients with pulmonary hypertension (PH) is associated with a heightened risk of medical complications including right heart failure, pulmonary edema, and arrhythmias. Our study investigated the association between PH and these complications during delivery. Methods and Results The National Inpatient Sample was used to identify delivery hospitalizations from 2011 to 2020. Multivariable logistic regression was performed to study the association of PH with the primary outcomes of in‐hospital medical and obstetric complications. A total of 37 482 207 delivery hospitalizations in women ≥18 years of age were identified, of which 9593 patients had PH. Pregnant patients with PH had higher incidence of complications during delivery including preeclampsia/eclampsia, arrhythmias, and pulmonary edema among others, compared with those without PH. Pregnant patients with PH also had a higher incidence of in‐hospital mortality compared with those without PH (0.51% versus 0.007%). In propensity‐matched analyses, PH was still significantly associated with a higher risk of in‐hospital mortality (odds ratio [OR], 5.02 [95% CI, 1.82–13.90]; P =0.001), pulmonary edema (OR, 9.11 [95% CI, 6.34–13.10]; P <0.001), peripartum cardiomyopathy (OR, 1.85 [95% CI, 1.37–2.50]; P <0.001), venous thromboembolism (OR, 12.60 [95% CI, 6.04–26.10]; P <0.001), cardiac arrhythmias (OR, 6.11 [95% CI, 4.97–7.53]; P <0.001), acute kidney injury (OR, 3.72 [95% CI, 2.86–4.84]; P <0.001), preeclampsia/eclampsia (OR, 2.24 [95% CI, 1.95–2.58]; P <0.001), and acute coronary syndrome (OR, 2.01 [95% CI, 1.06–3.80]; P =0.03), compared with pregnant patients without PH. Conclusions Delivery hospitalizations in patients with PH are associated with a high risk of mortality, pulmonary edema, peripartum cardiomyopathy, venous thromboembolism, arrhythmias, acute kidney injury, preeclampsia/eclampsia, and acute coronary syndrome.