BACKGROUND The population of female heart transplant recipients of reproductive age is growing, and counseling regarding reproductive decisions is important. We describe maternal and fetal outcomes of pregnancy in the Transplant Pregnancy Registry International. METHODS Data regarding pregnancies between 1987 and 2016 were collected via questionnaires, phone interviews, and medical records review. Demographics, comorbidities, changes in immunosuppressive regimens, rejection episodes during pregnancy, data on maternal retransplants, and deaths were recorded. RESULTS A total of 91 patients reported 157 pregnancies. Mean maternal age at conception was 27 ± 5.6 years. The most common indications for transplant were congenital heart disease (22%) and viral myocarditis (18%). Average transplant to conception interval was 7 ± 6.1 years. Immunosuppression was calcineurin inhibitor-based in almost all patients, with 20% of recipients taking mycophenolic acid (MPA) while pregnant. Complications during pregnancy included pre-eclampsia (23%) and infections (14%). Rejection was reported during 9% of pregnancies and within 3 months postpartum in 7%. Livebirths occurred in 69%, with no neonatal deaths. Miscarriages occurred in 26% of pregnancies, 49% of which had MPA exposure. Mean follow-up post pregnancy was 8.9 ± 6.5 years. At last follow-up, 30 recipients had died, an average of 9.4 ± 6.2 years after pregnancy. The most common causes included allograft vasculopathy and rejection. CONCLUSIONS This is the largest reported series of pregnancies in heart transplant recipients and demonstrates that two thirds of pregnancies reported are successful. MPA exposure is associated with increased risk of teratogenicity and miscarriage. Pre-pregnancy counseling should include discussions of risk of MPA exposure, rejection, graft dysfunction, and maternal survival.

中文翻译：

---

心脏移植受者的妊娠结局。

背景技术育龄的女性心脏移植受者的人数正在增长，并且关于生殖决策的咨询很重要。我们在“国际移植妊娠注册”中描述了孕产妇和胎儿的结局。方法通过问卷调查，电话访谈和病历审查收集有关1987年至2016年妊娠的数据。记录人口统计学，合并症，免疫抑制方案的变化，怀孕期间的排斥反应，母体再移植的数据以及死亡。结果共有91例患者报告了157例妊娠。受孕时的平均产妇年龄为27±5.6岁。最常见的移植指征是先天性心脏病（22％）和病毒性心肌炎（18％）。平均移植至受孕间隔为7±6.1年。在几乎所有患者中，免疫抑制都是基于钙调神经磷酸酶抑制剂的，其中20％的接受者在怀孕时服用了麦考酚酸（MPA）。怀孕期间的并发症包括先兆子痫（23％）和感染（14％）。据报道，在9％的怀孕期间和7％的产后3个月内，排斥反应都得到了拒绝。有69％的婴儿出生，没有新生儿死亡。流产发生在26％的孕妇中，其中49％患有MPA。怀孕后的平均随访时间为8.9±6.5年。在最后一次随访中，有30名接受者死亡，平均在怀孕后9.4±6.2年。最常见的原因包括同种异体血管病变和排斥反应。结论这是心脏移植接受者中最大的妊娠报告，证明三分之二的妊娠成功。MPA暴露会增加致畸性和流产的风险。孕前咨询应包括MPA暴露，排斥反应，移植物功能障碍和孕产妇生存风险的讨论。