When asthma meets pulmonary hypertension or peripartum cardiomyopathy in pregnancy: A systematic review and proposal for an integrated heart–lung perinatal care model
Bibliographic record
Abstract
Abstract: Pregnancy presents a unique cardiopulmonary stress test, during which asthma, pulmonary hypertension (PH), and peripartum cardiomyopathy (PPCM) may intersect through shared hypoxemic, inflammatory, and endothelial pathways. This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines to integrate evidence across respiratory, cardiac and obstetric disciplines. Comprehensive searches of PubMed, Embase, Scopus, Cochrane Library grey sources up to May 2025 identified 1380 records. After duplicate removal and screening, 40 studies met the inclusion criteria; 20 high-quality core studies were synthesised using AMSTAR-2, ROBINS-I and Newcastle–Ottawa frameworks. Data were extracted independently by two reviewers and integrated narratively by mechanistic domain and clinical phase. The synthesis demonstrates that asthma-related hypoxemia, eosinophilic inflammation and oxidative stress potentiate pulmonary vasoconstriction and right-ventricular strain, bridging towards PH and PPCM. Maternal mortality in modern PH pregnancies remains elevated despite improved multidisciplinary management, while uncontrolled asthma is consistently associated with preterm birth and foetal growth restriction. A new Integrated Heart–Lung Perinatal Care Model is proposed, defining oxygenation targets, biomarker thresholds and team-based escalation criteria to harmonise obstetric, pulmonary and cardiac care. Research priorities include precision asthma phenotyping, validation of oxygen-target algorithms, AI-supported early detection of decompensation and policy frameworks for equitable access to specialised care. This review followed PRISMA 2020 but was not prospectively registered. It establishes the first comprehensive framework uniting the mechanistic, clinical and policy dimensions of the asthma–PH/PPCM overlap in pregnancy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.090 | 0.147 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.014 | 0.017 |
| Bibliometrics | 0.014 | 0.013 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.007 | 0.009 |
| Open science | 0.005 | 0.004 |
| Research integrity | 0.005 | 0.004 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".