Normal physiologic changes during pregnancy and associated concerns in the heart transplant recipient

Physiologic changes	Associated concern in the pregnant heart transplant recipient
Increased blood volume	Hemodilution may affect serum drug levels.
Increased heart rate	Exacerbation is possible due to cyclosporine. The denervated heart does not respond to the autonomic nervous system.
Increased cardiac output	In a denervated heart, the cardiac output increases result primarily from volume changes and circulating catecholamines.
Increased stroke volume	Rejection may create systolic/diastolic dysfunction.
Right ventricular enlargement/tricuspid regurgitation	In patients requiring serial endomyocardial biopsies there is the potential for worsened tricuspid regurgitation.
Sodium retention	Increased edema; exacerbation of edema by prednisone.
Decreased T-lymphocytes and T-helper cells	Increased risk of infection; decreased risk of rejection.
Decreased glucose tolerance	Increased risk of diabetogenesis for patients on prednisone.
Decreased gastrointestinal motility and tone	Exacerbation of gastrointestinal symptoms with use of immunosuppressants. Exacerbation of reflux due to ulcerogenic effects of chronic steroids.
Increased risk of urinary tract infections	Risk increased secondary to immunosuppressive drugs.
Hyperemic/edematous gums	Worsened with immunosuppressive agents.
Increased risk of cholelithiasis	Exacerbated with use of azathioprine.

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