*Purpose: The purpose of this study was to describe 185 pregnancies in 108 heart transplant recipients.

*Methods: Data regarding conceptions occurring between June 1987 and Dec 2019 were collected by the Transplant Pregnancy Registry International (TPRI) via questionnaires, telephone interviews, and medical records. There were 5 recipients included from outside of North America.

*Results: The mean age at first transplant was 20±8.4 yrs (range 0.5-39.4 yrs). The transplant to conception interval was 7.7±6.1 yrs (range 0.15-26 yrs) and 44% of the pregnancies were reported as unplanned. Immunosuppression was calcineurin inhibitor-based with 20% exposed to a mycophenolic acid product (MPA). Comorbid conditions during pregnancy included: hypertension 49%, preeclampsia 29%, and diabetes requiring insulin 8%. Rejection occurred during 14 pregnancies (8%) and within 3 months post-partum in 11 pregnancies. Graft loss within 2 years of delivery occurred in 3 recipients; 1 recipient was successfully re-transplanted. Pregnancy outcomes (n=190, includes multiple births) included: 129 live births (16 with MPA exposure), 49 miscarriages (23 with MPA exposure), 8 terminations, 2 ectopic and 2 stillbirths. Of the 129 newborn the mean gestational age was 36.2 ± 3.4 wks and mean birth weight was 2586 ± 713 g; 42 children were breastfed. Birth defects were reported in 10 children and included: duodenal atresia, AV canal defect, Tetralogy of Fallot (MPA exposure); facial deformities (MPA exposure), laryngomalacia (MPA exposure), cystic hygroma, vermian hypoplasia of the cerebellum, hypospadias, undescended testicle, pectus excavatum, hydronephrosis, and tongue-tie. Seven children inherited their mother’s cardiac disease; 4 children have received a heart transplant. At last follow-up, mean 8.5 ± 6.8 yrs, 36 recipients had died (average age of their 40 children at time of maternal death was 10.2 ± 6.8 yrs), 6 had reduced cardiac function, 1 lost to follow-up, and 65 recipients reported adequate transplant function.

*Conclusions: This is the largest reported series of pregnancies in heart transplant recipients to date. Live births were reported in 68% of the pregnancies. MPA exposure continues to present significant concerns. Pre-pregnancy counseling should include discussion of the possibility of pregnancy, inheritable cardiac conditions, MPA avoidance, risk of rejection/graft dysfunction, and long-term maternal survival. All centers worldwide are encouraged to have their recipients participate in the TPRI.

« Back to 2021 American Transplant Congress