How Heart Transplants Support Birth and Rebirth

In the majority of cases, chronic heart failure is a contraindication to pregnancy because it could put the mother’s life in danger. During pregnancy and delivery, her heart has to work very hard. Certain medications prescribed for heart failure are known to cause birth defects (they’re considered a teratogen) and stopping them may destabilize heart failure.

A heart transplant, the final therapeutic solution for chronic terminal heart failure, restores normal cardiac function.

Thus, it’s perfectly understandable that a patient of procreation age whose pregnancy is contraindicated due to severe heart failure would want to have a heart transplant so she can then have a baby.

Having a baby after a heart transplant is possible with certain prerequisites:

- the heart transplant must be functioning well, as confirmed by a heart transplant center where specific examinations and expert assessments will be completed: echocardiography, coronary artery examination and possibly a stress test.

- teratogenic drugs must be stopped before conception to avoid birth defects. The immunosuppressants typically prescribed are teratogenic and can be changed by the cardiologist referring you for a transplant. Any change to immunosuppressants can lead to a risk of rejection. This risk must be taken into consideration and discussed with the patient.

- any extra cardiac pathology, such as chronic renal failure, must be verified to confirm it doesn’t contraindicate the pregnancy.

- genetic counseling should be offered if the heart transplant was required due to a genetic heart disease that could be passed on to the baby. Genetic analysis is then conducted and the risk of transmission is assessed. In some cases, embryos can be selected.

As the pregnancy is considered high-risk, monthly check-ups are completed from the beginning by the referral center for heart transplantation and gynecology-obstetrics. Particular attention should be paid to monitoring immunosuppressant levels, especially in the second trimester, as these fluctuate due to physiological changes in distribution volumes. Blood is therefore taken more frequently. Blood pressure and blood creatinine are also carefully monitored using ambulatory blood pressure measurements. Immunosuppressants cause high blood pressure and kidney failure.

Delivery procedures are discussed by a team including obstetricians, anesthesiologists and transplant cardiologists based on the cardiac data. Changes in immunosuppression at delivery are documented in the patient file because of the risk of rejection in the postpartum period. Immunosuppression is higher during this period.

Cardiac follow-up care is increased in the postpartum period to verify the absence of rejection, the main risk in this period. This risk is prevented by increasing anti-rejection medications.