PREGNANCY IN HEART-TRANSPLANT RECIPIENTS - MANAGEMENT AND OUTCOME

Objective: To determine the outcome of pregnancies in cardiac allograft recipients. Methods: Thirty women who became pregnant after heart transplantation were identified from cases managed personally, questionnaires sent to all cardiac transplant centers, and review of the literature. Mothers were evaluated for evidence of rejection and for obstetric complications. The infants were observed for congenital abnormalities and perinatal morbidity or mortality. Results: Frequent pregnancy complications included chronic hypertension (48%), preeclampsia (24%), and preterm labor (28%). The rate of cesarean delivery was 32%. Six episodes of rejection required treatment, and three late maternal deaths occurred. Among the 27 live births, 17 infants were born after 36 weeks' gestation and ten were preterm, five were small for gestational age, and four had neonatal complications. There were no congenital anomalies. Conclusion: Pregnancies in heart transplant recipients present management problems similar to those seen in patients with other allografts and should be considered high risk.