(661) Maternal and pregnancy outcomes following heart transplantation in the United States

Friday, February 10, 2023

10:30 AM – 12:00 PM

Objective: Improvement in survival following heart transplantation has led to increasing numbers of recipients contemplating pregnancy, but data on outcomes are limited. We used a large national dataset to describe outcomes of deliveries in the U.S. complicated by prior heart transplantation.

Study Design: Diagnosis and procedure codes from the 2010-2019 National Readmissions Database were used to identify delivery hospitalizations, history of heart transplantation (HT), comorbid conditions, and outcomes. We compared rates of severe maternal morbidity (SMM), non-transfusion SMM, cardiovascular SMM (cSMM), and preterm birth from the delivery hospitalization between HT recipients and No-HT patients. We also evaluated rates of readmission up to 330 days postpartum. Adjusted analyses were made using logistic and proportional hazard regression, adjusting for patient age, socioeconomic and facility characteristics, and clinical comorbidities; we additionally adjusted for the complex NRD survey design.

Results: Among 17,523,093 deliveries, 87 were in HT patients. HT patients were more likely to have comorbidities including asthma, chronic kidney disease, pre-gestational diabetes, chronic hypertension, obesity, and sickle cell disease (all p< 0.001). Compared to No-HT patients, HT patients were at higher risk for SMM (23.4% vs. 1.7%), non-transfusion SMM (21.6% vs. 0.68%), cSMM (8.5% vs. 0.12%), and preterm birth (44.3% vs. 8.0%), all p< 0.001 (Figure 1A). In adjusted analyses, HT patients had 14-fold odds of SMM, 30-fold odds of non-transfusion SMM, 46-fold odds of cSMM, and 7-fold odds of preterm birth (Figure 1B). HT patients had high readmission rates (30.1% vs. 3.8%; adjusted HR 5.64 [95% confidence interval 3.44-9.23], Figure 2).

Conclusion: Delivery with a history of HT is associated with increased rates of severe maternal morbidity and preterm birth, and patients are at increased risk of hospital readmission. These results provide concrete data regarding pregnancy outcomes for use when counseling patients with HT history who are considering pregnancy or who are pregnant.

Primary & Presenting Author(s)

Amanda M. Craig, MD (she/her/hers)
Maternal-Fetal Medicine Fellow
Duke University
Durham, North Carolina, United States

Coauthor(s)

AC
Alexa Campbell, MPH
Medical Student
Duke University Hospital
Chapel Hill, North Carolina, United States
SS
Sarah Snow, MD
Duke University
Durham, North Carolina, United States
AD
Anna Denoble, MD, MSCR
Yale University School of Medicine
New Haven, Connecticut, United States
RA
Richa Agarwal, MD
Duke University
Durham, North Carolina, United States
CW
Cary Ward, MD
Duke University
Durham, North Carolina, United States
Jerome J. Federspiel, MD, PhD
Duke University Hospital
Durham, North Carolina, United States