In-Hospital Outcomes in Pregnancy After Heart Transplantation

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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.

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Methods

We conducted a retrospective cohort study using data from the 2010 to 2015 NIS database. The NIS is compiled by the Healthcare Cost and Utilization Project and sponsored by the Agency for Healthcare Research and Quality; it includes a cross-sectional, stratified sample of approximately 20% of all discharges in the United States. Inpatient data from 46 states and the District of Columbia are included, which are estimated to account for more than 97% of the US population and more than 96% of

Results

A total of 21,922,631 delivery hospitalizations between 2010 and 2015 were analyzed; 94 hospitalizations occurred in HT recipients. Women who delivered after HT were significantly younger (26 vs 28 years, p <0.001) and had greater comorbidity burden than women without HT or HF, as evidenced by the Elixhauser Comorbidity Index (1.16 vs 0.24, p <0.001) (Table 1). Although this did not meet statistical significance, post-HT women were more likely to identify as Black and less likely to be

Discussion

Existing data on maternal and fetal outcomes after HT are limited and derived primarily from case reports, small series, and data from voluntary registries such as the NTPR and the UK Transplant Pregnancy Registry.2, 3, 4, 5 In this real-world study across hospitals in the United States, we found that delivery in HT recipients is uncommon, and pregnant women with a history of HT experienced an increased risk of HDP primarily driven by preeclampsia, and an increased risk of induction of labor

Disclosures

The authors have no conflicts of interest to declare.

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Cited by (2)

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  • Maternal and Pregnancy Outcomes Following Heart Transplantation in the United States

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