Pregnancy in cardiac transplant recipients

Abstract

We report a 91% live birth rate post-cardiac transplantation. Meticulous individualized care with frequent monitoring of CNI levels and LV function is necessary to optimize the maternal and fetal outcomes.

Pregnancy after heart transplantation: a well-thought-out decision? The Quebec provincial experience - a multi-centre cohort study

“…Alternatively, Bhagra et al . also showed similar outcomes in 22 pregnancies, of which 82% were unplanned, including 91% live births, and 9.1% miscarriages with a mean gestational age of 35 GW and without any drug‐induced malformation. One possible explanation might be that the medical teams were able to achieve a successful catch‐up, with intense follow‐up once they were aware of the ongoing pregnancy.…”

“…This progress may be due at least in part to earlier recognition of hypertension caused by CNI nephrotoxicity . Likewise, whether the higher incidence of diabetes can be awarded to the diabetogenic effect of tacrolimus remains controversial, with some reporting rates similar to ours (14%) , while others showing much lower incidence (0–2%), despite comparable immunosuppressive regimen . Indeed, other risk factors for gestational diabetes were present in our cohort, such as DiGeorge syndrome in one and First Nations origin for another patient .…”

Cardiac transplantation: indications, eligibility and current outcomes

“…Male recipients are advised to discontinue MMF/MPA before fathering children due to the risk of teratogenicity. The required dose of CNIs to maintain therapeutic levels increases markedly in the second trimester, however with frequent monitoring of drug levels pregnancy can be managed safely 67. Importantly, preconception counselling should highlight the limited longevity of the graft and the potential risk of an inherited cardiac condition.…”

Pregnancy and Heart Transplantation. First Case in Mexico

“…Unfortunately, between 50 to 82% of pregnancies are unscheduled, as happened with our recipient, who did not have regular contraception control [11][12][13].…”

“…Because of the benefits breast feeding brings to infants should be carefully weighed against the possible adverse effects of exposure to maternal immunosuppression. The conclusion of the AST Consensus conference was that breast feeding should not be absolutely contraindicated [9,10,13].…”