Pregnancy Outcomes Following Cardiac Transplantation

OBJECTIVE: This study sought to report pregnancy outcomes in women following cardiac transplantation. METHODS: This was a descriptive retrospective cohort study of women with pregnancies following cardiac transplantation managed at two large tertiary centres in Canada and Belgium between 2001 and 2017. RESULTS: Sixteen women had 17 singleton pregnancies following cardiac transplantation. The mean maternal age was 28 ± 5.8, and the transplant-to-pregnancy interval was 7.3 ± 4.0 years. There were two first trimester terminations, one for teratogenicity concerns and the other because of a maternal cardiac condition. There was one spontaneous miscarriage. All women had normal left ventricular function at the start of pregnancy. Graft rejection occurred in two women. Other maternal complications included anemia requiring blood transfusion (n = 5), renal failure or deterioration (n = 4), preeclampsia (n = 2), and urine infections (n = 2). The mean GA at delivery was 35 ± 3.5 weeks. Six infants were born preterm, and two were small-for-gestational-age. Fetal anomalies were identified in two pregnancies. Women were followed after pregnancy for a median of 5.6 years (range, 10 months to 15 years). Although there were no deaths during pregnancy, two women died at 10 and 18 months after delivery. CONCLUSION: With appropriate multidisciplinary care, women with cardiac transplants can have successful pregnancies. Although rates of fetal loss are low, these women continue to be at risk for graft rejection, preterm birth, other pregnancy-related complications, and cardiovascular death.