Pregnancy following cardiac transplantation

Cardiac transplantation is becoming more common, with over 3,000 cases annually in the United States. The increase in the number of cases and survival rates has resulted in a rise in the number of women of reproductive age receiving transplants. Special considerations for pregnant cardiac transplant recipients include the development of a baseline tachycardia (vagal denervation), asymptomatic myocardial ischemia (sensory denervation), tachyarrhythmias, and maternal death due to rejection. Perinatal morbidity and mortality are increased due to a rise in the incidence of preterm delivery, hypertensive disorders, renal insufficiency, small for gestational age infants, and infectious complications. The obvious benefits of immunosuppressant medications far outweigh any presumed fetal risks. A team approach to management can result in the most favorable outcome for mother and child.