Pregnancy outcomes in heart transplant recipients: a systematic review and meta-analysis of maternal and neonatal morbidities.
meta_analysis · Level I
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- Record sourced from PubMed, PMID 41297781.
- Also identified by DOI 10.1016/j.ajog.2025.11.028.
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Abstract
Advances in heart transplant (HT) have increased the number of reproductive-aged women with grafts considering pregnancy. However, this remains a high-risk scenario due to the potential for adverse outcomes. Current literature on comprehensive pregnancy outcomes and long-term graft implications remains limited. To evaluate maternal and neonatal outcomes of pregnancies in heart transplant recipients. We searched PubMed, EMBASE, the Cochrane Library, and Web of Science from their inception to May 2025 and reviewed the reference lists. We included observational cohort studies that reported maternal and fetal pregnancy outcomes in women with prior heart transplantation. Statistical analysis was performed using the R software; the pooled proportion was estimated using random-effects models (DerSimonian-Laird method). Quality assessment was conducted using a modified version of the Newcastle-Ottawa scale. Preeclampsia occurred in 19.32% (95% confidence interval, 14.14-25.82; I<sup>2</sup>=0%). and was associated with increased maternal mortality 19.70% (95% confidence interval, 14.80-25.75; I<sup>2</sup>=0%). Preterm birth 41.36% (95% confidence interval, 34.03-49.09; I<sup>2</sup>=0%) and lower birthweights (37.58%, 95% confidence interval, 30.18-45.62; I<sup>2</sup>=0.0%) were expressed. Low rates of graft loss during pregnancy were observed in 5.56% (95% confidence interval, 3.10-9.75; I<sup>2</sup>=0%). Cesareans were performed in 43.35% (95% confidence interval, 36.70-50.25; I<sup>2</sup>=2.2%), of patients, and the data of unplanned pregnancy reached 59.45% (95% confidence interval, 38.53-77.43; I<sup>2</sup>=79%) CONCLUSION: Pregnancy after HT is feasible but high-risk, with elevated rates of maternal morbidity, preterm birth, and neonatal complications. Preeclampsia significantly worsens neonatal outcomes but does not impair short-term graft survival. Multidisciplinary care, individualized immunosuppressive management, and rigorous preconception counseling are crucial for optimizing outcomes. These findings inform clinical decision-making and reproductive planning for HT women.
Medical subject headings
- Heart Transplantation
- Pregnancy Outcome
- Pregnancy Complications