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Maternal and Pregnancy Outcomes Following Heart Transplant
Quick Takes
- Compared to nonheart transplant patients, heart transplant recipients have 15-fold greater odds of severe maternal morbidity, 28-fold greater odds of nontransfusion severe maternal morbidity, 38-fold greater odds of CV-related severe maternal morbidity, and 7-fold greater odds of preterm birth.
- Heart transplant recipients have significantly higher readmission rates within 1-year post-partum compared to nonheart transplant patients (26.9% vs. 3.8%); 5.7% of heart transplant recipient readmissions were related to heart failure, myocardial infarction, cerebrovascular accident, graft failure or complication, and death.
- Heart transplant patients of child-bearing age should receive multidisciplinary counseling regarding the potential risks and outcomes for both the mother and child.
Study Questions:
What is the risk of pregnancy and delivery after heart transplantation?
Methods:
This retrospective cohort study from 2010–2020 reviewed the Nationwide Readmissions Database to compare heart transplant recipients versus nonheart transplant recipients for International Classification of Diseases (ICD)-9/ICD-10 diagnosis and procedure codes pertinent to delivery hospitalizations, comorbid conditions, and outcomes related to the incidence of severe maternal morbidity, nontransfusion severe maternal morbidity, cardiovascular (CV)-related severe maternal morbidity, preterm birth from delivery hospitalization, and readmissions up to 330 days post-partum. Logistic regression analysis adjusted for age, socioeconomics, clinical comorbidities. and type of facility.
Results:
Databases from 31 states were reviewed (total n = 19,399,521; heart transplant recipients n = 150). Compared with nonheart transplant deliveries, heart transplant recipients had a significantly higher risk for all severe maternal morbidity (24.8% vs. 1.7%), nontransfusion severe maternal morbidity (20.8% vs. 0.7%), CV-related severe maternal morbidity (8.5% vs. 0.12%), preterm birth (44.3% vs. 8.0%), pre-eclampsia without severe features (23.8% vs. 3.3%), pre-eclampsia with severe features (8.5% vs. 2.1%), and cesarean delivery (55.2% vs. 32.8%). Heart transplant recipients had higher mean lengths of hospital stay (6.2 vs. 2.7 days), inpatient charges ($63,458 vs. $18,003), morbidity during delivery, and readmission rates within 1 year (26.9% vs. 3.8%; adjusted hazard ratio, 6.03; 95% confidence interval, 3.73-9.75). Of those heart transplant recipients readmitted post-partum within 1 year, 5.7% were associated with heart failure, myocardial infarction, cerebrovascular accident, graft failure or complication, or death.
Conclusions:
Pregnant heart transplant recipients have significantly higher mortality and morbidity rates of severe maternal morbidity, preterm birth, and hospital readmissions compared to nonheart transplant patients.
Perspective:
Females of child-bearing age 18-49 years comprise 8% of heart transplant recipients. This study provides clinicians with evidence-based data to use when discussing the potential risks and outcomes for heart transplant candidates or recipients considering pregnancy. Compared to nonheart transplant patients, heart transplant recipients had 15-fold greater odds of severe maternal morbidity, 28-fold greater odds of nontransfusion severe maternal morbidity, 38-fold greater odds of CV-related severe maternal morbidity, and 7-fold greater odds of preterm birth. Although a limited size of this study, counseling for child-bearing heart transplant patients should include shared decision making regarding these potential risks for both the mother and child.
Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and Heart Failure, Acute Heart Failure, Heart Transplant
Keywords: Heart Failure, Heart Transplantation, Patient Care Team, Pregnancy, Premature Birth
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