Pregnancy outcomes in heart transplant recipients: a systematic review and meta-analysis of maternal and neonatal morbidities.

BACKGROUND

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.

OBJECTIVE

To evaluate maternal and neonatal outcomes of pregnancies in heart transplant recipients.

DATA SOURCES: We searched PubMed, EMBASE, the Cochrane Library, and Web of Science from their inception to May 2025 and reviewed the reference lists.

STUDY ELIGIBILITY CRITERIA: We included observational cohort studies that reported maternal and fetal pregnancy outcomes in women with prior heart transplantation.

STUDY APPRAISAL AND SYNTHESIS

METHODS

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.

RESULTS

Preeclampsia occurred in 19.32% (95% confidence interval, 14.14-25.82; I2=0%). and was associated with increased maternal mortality 19.70% (95% confidence interval, 14.80-25.75; I2=0%). Preterm birth 41.36% (95% confidence interval, 34.03-49.09; I2=0%) and lower birthweights (37.58%, 95% confidence interval, 30.18-45.62; I2=0.0%) were expressed. Low rates of graft loss during pregnancy were observed in 5.56% (95% confidence interval, 3.10-9.75; I2=0%). Cesareans were performed in 43.35% (95% confidence interval, 36.70-50.25; I2=2.2%), of patients, and the data of unplanned pregnancy reached 59.45% (95% confidence interval, 38.53-77.43; I2=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.