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Majority of Post-Heart Transplant Pregnancies End in Live Births


 

BOSTON — Live births occurred in 70% of heart transplant recipients who became pregnant after surgery, according to a review of 36 patients with 60 singleton pregnancies reported to the National Transplantation Pregnancy Registry.

Of 42 live-born children, 36 were healthy and developing well at the time of follow-up. Three children were receiving medical management for cardiomyopathy, the same diagnosis for which their mothers received transplants. Among the other three children, one underwent a hypospadias repair, one was treated for attention-deficit hyperactivity disorder, and one died from a traumatic injury, Lisa A. Coscia reported during a poster session at the 2006 World Transplant Congress.

These 42 children were born at a mean gestational age of 37 weeks (5 were premature) and with a mean birth weight of 2.67 kg. A cesarean section was performed in 14 deliveries. Neonatal complications developed in 11 cases.

In the 18 unsuccessful pregnancies, 11 fetuses were aborted spontaneously and 5 for therapeutic reasons. One woman had an ectopic pregnancy and another had a stillborn delivery, according to Ms. Coscia, a registered nurse in the department of surgery at Temple University, Philadelphia.

The 36 patients conceived their pregnancies a mean of 5 years after their transplants, although this ranged from as little as 0.2 years to as much as 15 years. They had an average age of 28 years at conception, ranging from 18 to 39 years.

During pregnancy, hypertension was the most common comorbidity (43%) among the women, followed by infections (14%), preeclampsia (11%), and gestational diabetes (3%).

Nine of the mothers (25%) died after pregnancy, although all of the deaths occurred more than 2 years post partum. These deaths were attributed to cardiac arrest (two), acute rejection (two), and in one patient each, vasculopathy, atherosclerosis, sepsis, lymphoma, and noncompliance. The other 27 mothers (75%) had adequate graft function at follow-up.

According to data collected by the U.S. Organ Procurement and Transplantation Network, the 5-year Kaplan-Meier patient survival rate for heart transplants performed in women between 1997 and 2004 (pregnancies not considered) is just over 69%.

The possibility of maternal death unrelated to pregnancy should be included during prepregnancy counseling, Ms. Coscia advised in her poster at the congress, which was sponsored by the American Society of Transplant Surgeons, the American Society of Transplantation, and the Transplantation Society.

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