RISKS OF SUBSEQUENT PREGNANCIES ON MOTHER AND NEWBORN IN FEMALE HEART-TRANSPLANT RECIPIENTS

Background: Female heart transplant recipients are able to carry pregn ancies successfully. This study evaluates the effect of subsequent pre gnancies on newborn and maternal outcomes and graft survival. Methods: Subjects were identified through a previously reported multicenter st udy, case reports from literature review, and recipients entered in th e National Transplantation Pregnancy Registry. A retrospective analysi s was completed of 35 heart transplant recipients with first pregnanci es (FP) and 12 who had one or two additional pregnancies (P > 1). Newb orns were assessed for gestational age, neonatal birth weight, and com plications. Maternal data included pregnancy outcome, peripartum compl ications, including infection and rejection, current graft function, a nd recipient survival. Results: Forty-seven pregnancies (35 FP and 12 P > 1) from 35 heart transplant recipients were studied. FP outcomes i ncluded 26 Live births (one set of twins), four miscarriages, and six therapeutic abortions, whereas P > 1 outcomes included ii live births (one set of twins), and two miscarriages. There was no significant dif ference between mean birth weights (2353 +/- 986 gm vs 2588 +/- 521 g, P > 1 vs FP; mean +/- SD; p = NS) or prematurity incidence (< 37 week s; 50% vs 40%; p = NS) for the live-born infants. Compared with the FP group, there was a trend toward increased neonatal complications in P > 1 (40% vs 12%; p = NS), Complications were significantly more commo n in premature newborns compared with full-term newborns (33% vs 5%; p < 0.05). No structural malformations were identified in the live-born infants. Maternal complication rates were the same in both groups (40 %). Of 28 recipients available for follow-up, the maternal survival ra te was 75% for the FP group and 89% for the P > 1 group. Mean rejectio n rate per year was slightly increased after pregnancy in the P > 1 gr oup. Surviving recipients had similar graft function by echocardiograp hic left ventricular ejection fraction. Conclusions: Post-heart transp lantation pregnancies often have successful outcomes, but there is a h igh incidence of prematurity and low birth weight. Subsequent pregnanc ies do not seem to significantly increase the incidence of complicatio ns in either the newborn or mother or increase graft rejection or fail ure. Larger studies of posttransplantation pregnancies may provide mor e definitive information.