In-Hospital Outcomes in Pregnancy After Heart Transplantation

Although the number of successful pregnancies in heart transplantation (HT) recipients is increasing, data regarding outcomes after delivery are limited. The 2010 to 2015 Nationwide Inpatient Sample was queried to identify index hospitalizations for delivery in HT recipients. Adverse delivery events of HT patients were compared with those of women without history of HT or systolic heart failure (HF) undergoing delivery. Of 21,922,631 delivery hospitalizations, 94 hospitalizations were of HT recipients. Compared with women without a history of HF or HT, post-HT women had greater comorbidity burden, as evidenced by the Elixhauser Comorbidity Index (1.16 vs 0.24, p <0.001), lower household incomes (p = 0.03), and were more likely to deliver at large hospitals (90% vs 58%, p = 0.02) and hospitals categorized as teaching institutions (100% vs 59%, p <0.001). After adjustment for clinical variables, history of HT was significantly associated with increased incidence of hypertensive disorders of pregnancy (odds ratio 6.97, p = 0.001) primarily driven by increased rates of preeclampsia, and induction of labor (odds ratio 3.18, p = 0.01). There were no differences in gestational diabetes, cesarean section, fetal growth restriction, fetal malformations, or preterm delivery (all p >0.3). In conclusion, post-HT women have greater comorbidity burden and experience increased maternal risks compared with women without history of HT or systolic HF, including increased risk of hypertensive disorders of pregnancy and need for induction. More studies are needed to improve obstetric care and maternal-fetal outcomes for the HT population.