Pregnancy Following Heart Transplantation: A Single Centre Case Series and Review of the Literature.
BACKGROUND
Maternal and fetal outcomes of pregnancy amongst cardiac transplant recipients are limited in the current literature.


METHODS
We describe five pregnancies in three cardiac transplant recipients managed between a tertiary centre for obstetric medicine and an associated state-wide transplant centre between 2014-2018, and provide a narrative review of the literature.


RESULTS
Pre-conception counselling was undertaken. There were no recent rejection episodes and all women demonstrated good baseline cardiac function. Median maternal age was 27 years (range 23-38 yrs.). Median time from transplantation to pregnancy was 5 years (range 2-14 yrs.). All women were managed with modified immunosuppressant regimens and multidisciplinary care. Cardiac function, tacrolimus levels and renal function were closely monitored with frequent monitoring for common complications of pregnancy. There were no maternal or fetal deaths. There was no evidence of graft rejection and no deterioration in cardiac function. Tacrolimus doses were increased to maintain therapeutic targets. Gestational diabetes occurred in three women and cholestasis of pregnancy occurred in one. Each infant was delivered by vaginal delivery. One mother had postpartum haemorrhage in both pregnancies. Pre-eclampsia did not occur. Median gestation at delivery was 37 weeks (range 35+4-40+5 days) with two preterm deliveries. One (1) infant was born with low birth weight. One (1) infant had jaundice requiring phototherapy. All infants were breastfed.


CONCLUSION
Pregnancy in transplant recipients confers risk to the mother and fetus. Pre-conception counselling, immunosuppressant tailoring and regular monitoring are paramount to avoid rejection and possible teratogenic complications. Favourable pregnancy outcomes are achievable with specialist multidisciplinary care.
['Boyle|Siobhan|S|', 'Sung-Him Mew|Thomas|T|', 'Lust|Karin|K|', 'McKenzie|Scott|S|', 'Javorsky|George|G|', 'Parsonage|William|W|']
D000293:Adolescent D000328:Adult D005260:Female D016027:Heart Transplantation D006801:Humans D007231:Infant, Newborn D011247:Pregnancy D011249:Pregnancy Complications, Cardiovascular D011256:Pregnancy Outcome D012189:Retrospective Studies D066027:Transplant Recipients D055815:Young Adult
Pregnancy Heart transplantation Cardiac disease in pregnancy Women's cardiovascular health