Pregnancy after cardiac transplantation. Report of one case and review

Abstract

A 14-year-old female patient became pregnant 6 years after heart transplantation. The pregnancy evolved uneventfully, and the newborn infant was healthy. Five months after delivery, the mother was in good condition with preserved ventricular function, and the baby had normal neuro-psychomotor development. Even though the case reported here was a success, pregnancy following cardiac transplantation is considered a high-risk condition and remains contraindicated.

Pregnancy in heart transplant recipients

“…10 To our knowledge, 86 cases of pregnancy after heart transplantation have been reported so far. 6,[25][26][27][28][29][30][31][32] The largest survey was carried out by the U.S. National Transplant Registry, which included 47 pregnancies. Of these, 35 women were in their first pregnancy and 12 had previous deliveries.…”

A second delivery after heart transplantation – a case study

“…Female heart transplant recipients desiring offspring must be informed of both the risks related to the influence of immunosuppressants on fetal development and the dangers associated with the high number of complications pertaining to the pregnancy and transplant [ 5 , 11 ]. Such complications include arterial hypertension, pre-eclampsia, infections (especially viral), and intrauterine growth restriction [ 3 , 4 ]. If, before the pregnancy, the function of the transplanted heart had been normal, the physiological hemodynamic changes related to the pregnancy are usually well tolerated.…”

A Successful Pregnancy and Delivery after Heart Transplantation: The First Case Report from Korea

“…However, pregnancy in heart transplant recipients imposes significant risks to the mother, graft, and the fetus (3). Such pregnancies carry increased risk of obstetric complications including pre-eclampsia, spontaneous abortions, low birth weight, and intrauterine growth re-striction (IUGR) (4,5).…”

“…Our current report describes the first Korean case of a heart transplant recipient who gave birth to a healthy child. Clinical practice regarding pregnancy management in women after transplantation of vital organs is mostly based on expert recommendations, and there are no guidelines constructed on the basis of randomized controlled trials due to the small number of heart transplant recipients(2,4,5). The considerations for cardiologists providing care for female heart transplant recipients include pre-conception counseling, maternal and fetal risks during gestational period, intrapartum and post-partum care, and breast feeding.…”