PREGNANCY IN HEART-TRANSPLANT RECIPIENTS - MANAGEMENT AND OUTCOME

Objective: To determine the outcome of pregnancies in cardiac allograf t recipients. Methods: Thirty women who became pregnant after heart tr ansplantation were identified from cases managed personally, questionn aires sent to all cardiac transplant centers, and review of the litera ture. Mothers were evaluated for evidence of rejection and for obstetr ic complications. The infants were observed for congenital abnormaliti es and perinatal morbidity or mortality. Results: Frequent pregnancy c omplications included chronic hypertension (48%), preeclampsia (24%), and preterm labor (28%). The rate of cesarean delivery was 32%. Six ep isodes of rejection required treatment, and three late maternal deaths occurred. Among the 27 live births, 17 infants were born after 36 wee ks' gestation and ten were preterm, five were small for gestational ag e, and four had neonatal complications. There were no congenital anoma lies. Conclusion: Pregnancies in heart transplant recipients present m anagement problems similar to those seen in patients with other allogr afts and should be considered high risk.