Pregnancy Outcomes in Female Heart Transplant Recipients with the Initial Diagnosis of Congenital Heart Defect

• Published in: The Journal of heart and lung transplantation Vol. 32; no. 4; p. S129
• Main Authors: Coscia, L.A, McGrory, C.H, Ohler, L, Moritz, M.J, Armenti, V.T
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2013
• Subjects: Surgery
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2013.01.284

Purpose The purpose of this study was to describe pregnancy in female heart recipients who received their transplant due to a congenital defect. Methods and Materials Data were collected by the National Transplantation Pregnancy Registry (NTPR) via questionnaires, phone interviews, and medical records. Results There are 65 heart recipients with 113 pregnancies reported to the NTPR to date. Of these, 14 recipients (22 pregnancies) had an initial diagnosis of a congenital heart defect (hypoplastic left heart syndrome 4, transposition of the great vessels 3, tricuspid atresia 2, septal defect 1, fibroelastosis 1, two-chambered heart 1, and other 2). Mean age at first transplant was 14±10.7 yrs. The transplant to conception interval was 4.7±3.4 yrs. Immunosuppression during the pregnancies was calcineurin-inhibitor based with mycophenolic acid product (MPA) exposure in 11. Outcomes were 7 miscarriages (all MPA exposure) and 15 live births with a mean gestational age of 36.7±2.4 wks and a mean birthweight of 2586±546 g. There were 5 children with birth defects: 1 with duodenal atresia, Tetralogy of Fallot and atrioventricular canal defect (MPA exposure), 1 with facial defects (MPA exposure), 1 pectus excavatum, 1 atrial septal defect, and 1 long QT syndrome. Comorbid conditions during pregnancy: hypertension 7, preeclampsia 4, and infection 3. One recipient had mild rejection during pregnancy treated with an increase in oral prednisone. One recipient was retransplanted 12 yrs post-delivery but subsequently died, and 13 recipients reported adequate graft function. Conclusions Female heart transplant recipients born with congenital heart defects have reported successful pregnancies with a majority reporting adequate graft function postpartum. MPA exposure in this group confirms increases in miscarriages and birth defects. The higher frequency of birth defects in the offspring not exposed to MPA in utero in this group warrants further study.