Pregnancy Outcomes Following Cardiac Transplant [31F]

INTRODUCTION: We report a single-center experience of pregnancy outcomes for women following cardiac transplantation. METHODS: This is a retrospective cohort of all women with pregnancies following cardiac transplantation followed at Mount Sinai Hospital, Toronto, between 2001-2015. RESULTS: Five women had five singleton pregnancies following cardiac transplantation. The mean maternal age was 28.4 (±7.7) years and transplant-to-pregnancy interval was 7.1 (±3.6) years. Pre-existing comorbidities included hypertension in three and diabetes in one. Two women experienced graft rejection prior to conception, but had normal left ventricular (LV) function at the start of pregnancy. Three women were on a calcineurin inhibitor (cyclosporine or tacrolimus) with 5-10 mg prednisone per day, one was on tacrolimus + mycophenolate mofetil and one was on cyclosporine, azathioprine and prednisone. There were no maternal deaths. Maternal complications included preeclampsia in one and graft rejection in two. There were four live births (80%) with a mean gestational age of 33+3 (27+6 - 37+3) weeks. There were no fetal anomalies or cases of growth restriction, but two preterm births, one from spontaneous labor at 27+6 weeks and the other from labor induction for preeclampsia at 34+2 weeks. The infant delivered at 27+6 weeks had no residual sequelae at four months post-term age. Three women (75%) had caesarean deliveries for obstetric indications. CONCLUSION: With appropriate multidisciplinary care, women with cardiac transplants can have successful pregnancies. Although rates of fetal loss and congenital malformations are low on current immunosuppressive regimens, women may continue to be at risk for preterm birth.