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A New Life: Motherhood After Heart Transplantation. A Single-center Experience and Review of Literature

Macera, Francesca, MD1; Occhi, Lucia, MD1; Masciocco, Gabriella, MD1; Varrenti, Marisa, MD1; Frigerio, Maria, MD1

doi: 10.1097/TP.0000000000002281
Original Clinical Science—General

Background Pregnancy after heart transplantation (HTx) may expose the recipient to hemodynamic and immunologic risks and the newborn to toxic effects of immunosuppressive therapy. Adequate preconception counseling is crucial to identify optimal timing and to modify immunosuppressive therapy to minimize risks for both the mother and the fetus.

Methods We describe our experience with 12 pregnancies occurred in 11 women who had undergone HTx at our center.

Results Pregnancies ran without severe complications or rejections, and none of the babies have shown major defects at birth. However, as reported in the literature, weight at birth rated in lower range in most of the newborns, probably due to in utero cyclosporine exposure. Up to now, none of the babies showed clinical signs of heart disease, although more than half of the mothers had an inherited or familial cardiomyopathy.

Conclusions Despite potential mother and fetal complications, successful pregnancy and delivery are possible after HTx, provided that optimum timing, close monitoring, and therapy adjustments are guaranteed. Becoming a mother appears to be an important achievement for young women after HTx, even when there is a risk to transmit an inheritable heart disease.

Pregnancy is a rare event after heart transplantation. The authors describe the results of pregnancy in 12 patients with a clear description of the risks and of the special care to be given to these patients.

1 2nd Section of Cardiology, Heart Failure and Transplant Unit, DeGasperis CardioCenter, Niguarda Great Metropolitan Hospital, Milan, Italy.

Received 28 November 2017. Revision received 24 March 2018.

Accepted 30 March 2018.

The authors declare no conflicts of interest.

M.F., O.L., M.V. acquired the data. M.F. and O.L. drafted the article. M.G. and F.M. made critical revision for key intellectual contents.

Correspondence: Francesca Macera, 2nd Section of Cardiology, Heart Failure and Transplant Unit, DeGasperis CardioCenter, Niguarda Great Metropolitan Hospital, 20162 Milan, Italy. (francesca.macera@ospedaleniguarda.it).

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