Reproductive health after thoracic transplantation: An ISHLT expert consensus statement

Kittleson, M.; DeFilippis, Ersilia M.; Bhagra, Catriona; Casale, Jillian P.; Cauldwell, Matthew; Coscia, Lisa A.; D’Souza, Rohan; Gaffney, Nicole; Gerovasili, Vasiliki; Ging, Patricia; Horsley, Kristin; Macera, Francesca; Mastrobattista, Joan M.; Paraskeva, Miranda; Punnoose, L.; Rasmusson, Kismet; Reynaud, Quitterie; Ross, Heather J.; Thakrar, Mitesh V.; Walsh, Mary Norine

doi:10.1016/j.healun.2022.10.009

Cited by 18 publications

(62 citation statements)

References 276 publications

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“…In addition, increased preload to right ventricle (RV) during pregnancy and volume shifts to the maternal circulation after delivery of the placenta could worsen RV function. Afterload increase in patients who develop hypertension or preeclampsia can decrease LVAD flows and worsen heart failure syndrome [11 ▪▪ ].…”

Section: Hemodynamic Changes In Pregnancymentioning

confidence: 99%

“…There is a paucity of data on pregnant women with prior medical history of HT and limited to observational studies, small cohorts or registry reports [1 ▪▪ ,12,13]. The ISHLT released a comprehensive consensus guideline document on reproductive health after thoracic transplantation in 2022 [11 ▪▪ ].…”

Section: Heart Transplantationmentioning

confidence: 99%

“…Approximately, half of patients in the TPR were treated for hypertension during pregnancy, 23% developed preeclampsia, 11.5% experienced worsening renal function, and 14% developed infections [1 ▪▪ ,13]. Maternal death occurred in 12–33%, 1–9.4 years after pregnancy [11 ▪▪ ]. In a systematic review of pregnancy outcomes in HT recipients, maternal mortality during pregnancy was 0.5% [13].…”

Section: Maternal Complicationsmentioning

confidence: 99%

“…Live births in HT recipients range from 70% to 80% with one single-center study reporting 91% live births likely due to carefully selected patients and multidisciplinary care. Approximately, half of the deliveries are preterm [11 ▪▪ ]. Low birth weight (<2500 g) is reported in approximately 45% and congenital malformations in 8–14% of deliveries [11 ▪▪ ].…”

Section: Obstetrical and Fetal Outcomesmentioning

confidence: 99%

“…Approximately, half of the deliveries are preterm [11 ▪▪ ]. Low birth weight (<2500 g) is reported in approximately 45% and congenital malformations in 8–14% of deliveries [11 ▪▪ ]. The rate of reported miscarriages in the TPR was 25% [1 ▪▪ ].…”

Section: Obstetrical and Fetal Outcomesmentioning

confidence: 99%

See 4 more Smart Citations

Management of pregnancy in left ventricular assist device and heart transplant recipients: a concise review

Marek-Iannucci

Uber

Rajapreyar

2023

Current Opinion in Cardiology

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Purpose of reviewWomen of reproductive age are increasingly undergoing heart transplantation (HT) or left ventricular assist device (LVAD) implantation for advanced heart failure. This review is intended to give an overview of the current state of the art management of pregnancy in patients with LVAD or HT recipients.Recent findingsHeart transplant recipients are at increased risk for graft rejection, renal dysfunction, preeclampsia and worsening of comorbidities (hypertension and diabetes). Patients with LVAD are at higher risk of thromboembolic events, infections, right ventricular failure and require close surveillance during pregnancy. Preconception counseling must be offered to all women of reproductive age group with HT or LVAD to avoid unplanned pregnancies.SummaryA multidisciplinary approach with close antepartum and postpartum surveillance is recommended.

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Section: Hemodynamic Changes In Pregnancymentioning

confidence: 99%

Section: Heart Transplantationmentioning

confidence: 99%

Section: Maternal Complicationsmentioning

confidence: 99%

Section: Obstetrical and Fetal Outcomesmentioning

confidence: 99%

Section: Obstetrical and Fetal Outcomesmentioning

confidence: 99%

See 3 more Smart Citations

Management of pregnancy in left ventricular assist device and heart transplant recipients: a concise review

Marek-Iannucci

Uber

Rajapreyar

2023

Current Opinion in Cardiology

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Sex Differences in Cardiac Transplantation

Chung,

Hartman,

DeFilippis

2023

Curr Atheroscler Rep

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Contemporary Management of Cardiomyopathy and Heart Failure in Pregnancy

Afari,

Sheehan,

Reza

2024

Cardiol Ther

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Cardiovascular disease is the primary cause of pregnancy-related mortality and morbidity in the United States, and maternal mortality has increased over the last decade. Pregnancy and the postpartum period are associated with significant vascular, metabolic, and physiologic adaptations that can unmask new heart failure or exacerbate heart failure symptoms in women with known underlying cardiomyopathy. There are unique management considerations for heart failure in women throughout pregnancy, and it is imperative that clinicians caring for pregnant women understand these important principles. Early involvement of multidisciplinary cardio-obstetrics teams is key to optimizing maternal and fetal outcomes. In this review, we discuss the unique challenges and opportunities in the diagnosis of heart failure in pregnancy, management principles along the continuum of pregnancy, and the safety of heart failure therapies during and after pregnancy.

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Reproductive health after thoracic transplantation: An ISHLT expert consensus statement

Cited by 18 publications

References 276 publications

Management of pregnancy in left ventricular assist device and heart transplant recipients: a concise review

Management of pregnancy in left ventricular assist device and heart transplant recipients: a concise review

Sex Differences in Cardiac Transplantation

Contemporary Management of Cardiomyopathy and Heart Failure in Pregnancy

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