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Practice Patterns Surrounding Pregnancy After Heart Transplantation.

Ersilia M DeFilippis1, Jennifer Haythe1, Maryjane A Farr1

  • 1Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York (E.M.D., J.H., M.F.).

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Summary

Provider attitudes towards pregnancy after heart transplantation (HT) vary significantly. Many providers believe pregnancy should be avoided, and most centers lack formal policies, highlighting a need for better education on post-HT pregnancy feasibility.

Keywords:
attitudefemaleheart transplantationimmunosuppressionpregnancy

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Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Reproductive Health

Background:

  • Pregnancy after heart transplantation (HT) is a growing concern for female recipients.
  • Existing guidelines from the International Society for Heart and Lung Transplantation address reproductive health, but provider perspectives are not well-documented.

Purpose of the Study:

  • To assess the attitudes and practices of United States heart transplant providers regarding pregnancy in heart transplant recipients.

Main Methods:

  • An independent, confidential, voluntary web-based survey was distributed electronically to 1643 US heart transplant providers in June-August 2019.
  • The survey collected data on provider recommendations and center policies concerning pregnancy post-heart transplantation.

Main Results:

  • 122 providers responded, primarily cardiologists and transplant coordinators.
  • 31% of respondents recommended avoiding pregnancy in all HT recipients.
  • Only 43% of centers had a formal policy for managing pregnancy post-HT, with common contraindications including nonadherence and reduced ejection fraction.

Conclusions:

  • Provider attitudes towards post-HT pregnancy are diverse, with a notable portion recommending avoidance.
  • The majority of heart transplant programs lack specific policies for managing pregnancy, despite established guidelines.
  • There is a clear need for enhanced education regarding the feasibility of pregnancy after heart transplantation for recipients of childbearing age.