In the last years, the surgical progress led to progressive increase of number and survival time of heart transplant female recipients. While, the quality of their reproductive life,  assumed important relief.Counseling for contraception when sterilization is not desired, must take into account the increased risk of infection and genital carcinoma associated with immunosuppressant drug therapy   ⁽¹⁾.

Teratogenicity has not been reported either with traditional immunosuppressive agents (prednisone, azathioprine) or with cyclosporine. Osteoporosis prophylaxis is particularly important in the female heart transplant recipient,  because the chronic use of prednisone increases this risk. Guidelines are provided to counsel patients in these areas. ⁽²⁾. 

Generally, reproductive function improves after transplant and many cases of pregnancy had been reported in this time. The female transplant recipient attempting successful conception,  pregnancy,  and delivery ^(3,4).

When the couple has completed the familial nucleus or does not desire offspring, is important to realize whether safer method of contraception is advisable in such women.

The new low-dose hormonal contraceptives can provide suitable birth control in these women but accurate and correct information about both, risks and advantages is mandatory ⁽⁵⁾.

It is obligatory that the choice of a contraceptive takes into account the possible development of arterial hypertension often associated to immunosuppressive therapy and, the possible effects of the conbined formulation on coagulation and,  carbohydrate and lipid metabolisms ^(5,6).

However, a study carried-our on twenty-four female transplant recipient, before of pregnancy, reported no side-effects during combined oral contraceptive use without the need for increasing the doses of antihypertensive drugs ⁽⁶⁾.

Generally,  low-dose gestagen preparations are indicated for high risk patients, while low-dosage combined preparations may be indicated for low-risk cardiac patients ⁽⁷⁾.

Therefore, choice of progestagen would be guided considering its metabolic effects.

Unfortunately, hormonal contraception in heart transplant female recipients, is hitherto unresolved issue; however its use can avoid in first instance a tubal ligature. 

—
Rosa Sabatini
General Hospital Policlinico, University of Bari, Italy
—

REFERENCES

1.   Meier, P.R., Makowski, E.L. (1984). Pregnancy in the patient with a renal transplant.Clin. Obstet. Gynecol, Dec, 27(4), 902-13. 
2.   Kossoy,  L.R.,  Herbert,  C.M.,Wentz,  A.C.  (1988).  Management of heart transplant recipients:  guidelines for the obstetrician-gynecologist.  Am.  J. Obstet. Gynecol, 159(2), 490-9. 
3.   Akin,  S.J.  (1992).  Pregnancy   after   heart   transplantation.  Prog. Cardiovasc.Drug, 7(3), 2-5. 
4.   Maurer,  G.,  Abriola,  D.  (1994).  Pregnancy following renal transplant.  J. Perinat. Neonatal. Nurs,8(1), 28-36. 
5.   Spina,  V.,  Aleandri,  V.,  Salvi,  M.  (1998).  Contraception after heart transplantation. Minerva Ginecologica, 50(12), 539-43.
6.   Seifert-Klauss,  V.,  Kaemmerer,  H.,  Brunner,  B.,  Schneider,  K.T.,  Hess,  J. (2000). Contraception in patients with congenital heart defects.  Z.  Kardiol, 89(7), 606-11.
7.   Taurelle,  R.  (1979).  Micro-pill use by cardiac patients.  Contracept.  Fertil Sex. (Paris), 7(11),789-93.