A large study with a nationwide sample suggests that one-quarter of pregnant women with a history of heart transplants will experience severe maternal morbidity during their hospital admission for delivery. Moreover, they also have a greater risk of preterm birth compared to other pregnant women.
The cohort study consisted of information from 2010–202 using the Nationwide Readmissions Database. It is a large all-player administrative dataset that helps track hospital readmissions in the same state of the USA within the same calendar year. Furthermore, it includes demographics, characteristics of the hospital, diagnosis and procedure codes, length of hospital admission, and discharge disposition.
The primary outcome was non-transfusion-related severe maternal morbidity. Furthermore, the other conditions included acute MI, aortic aneurysm, acute renal failure, adult respiratory distress syndrome, cardiac arrest/ventricular fibrillation, and heart failure during hospitalization for delivery.
In addition, the other outcomes include severe maternal morbidity (including transfusion); cSMM (composite cardiovascular SMM), which included acute MI, aortic aneurysm, cardiac arrest/ventricular fibrillation, cardioversion, and acute heart failure, preterm birth, and readmission rates.
From 2010 to 2020, 19,399,521 hospital deliveries consisted of 105 HT recipients. However, the rates of all outcomes were higher in patients with HT compared to non-HT deliveries. Moreover, even after adjusting the age, demographics, characteristics of the facility, and comorbid conditions, the cases of HT recipients remained higher. They had longer hospital stays and cesarian deliveries.
However, the authors noted that it isn’t clear whether this increase was due to HT or pregnancy complications. Since there was no data available for indication of cesareans. Moreover, patients with HT also had an increased risk of hospital readmission for the first year post-delivery. The guidelines recommend an initial postpartum visit within the first two weeks of discharge for patients with cardiac conditions.
The authors conclude,
To provide information about anticipated risks in pregnancy and the postpartum period to allow patients the opportunity to make informed choices regarding their reproductive options
