New Jersey Mother Delivers Twins After Receiving Heart Transplant
By Newark Beth Israel Medical Center
2/5/2010
When Stefania De Mayo of Wayne, NJ, received her heart transplant in August 2008 at the Heart Failure Treatment and Transplant Program at Newark Beth Israel Medical Center (NBIMC), she and her husband were already hoping to be parents. On Wednesday, the couple brought their second twin daughter home from the hospital after several weeks in the Neonatal Intensive Care Unit (NICU) at Childrens Hospital of New Jersey at NBIMC. The first baby was discharged from the NICU on January 14. This is the only known case of twins born to a mother who had a heart transplant.
"I wanted a transplant because it meant I could have children," said Ms. De Mayo, who had a rare heart condition known as restrictive cardiomyopathy that results in a stiffening of the heart muscle and eventually results in heart failure.
The twins, Melania and Natalia, were born at Newark Beth Israel Medical Center on December 29, just 16 months following Ms. De Mayos heart transplant. Their premature birth, six weeks early, was due to complications related to twin-twin fetal transfusion syndrome, not Ms. De Mayos heart.
"Ms. De Mayo was in uncharted waters," said David Baran, MD, transplant cardiologist and Director of Heart Failure and Transplant Research at NBIMC. "Worldwide, there have been only 39 reported pregnancies after heart transplant. The birth of these two healthy babies was due to the extraordinary multidisciplinary team of specialists in heart transplant, high-risk pregnancy and neonatolgy who worked together to protect the lives of both the mother and infants," stressed Dr. Baran.
"So much is still unknown about the function of the immune system during pregnancy. There was always the risk that Ms. De Mayos body would reject her transplanted heart," explained Dr. Baran. Fortunately, Ms. De Mayo is part of a unique clinical trial being conducted only at Newark Beth Israel Medical Center. She takes just one immunosuppressive medication Prograf to prevent organ rejection, while heart transplant recipients at other centers take three medications. Unlike other immunosuppressive drugs, Prograf is less likely to cause birth defects.
Director of Maternal and Fetal Medicine Munir Nazir, MD, closely managed the progress of the twins throughout their gestation. He diagnosed the rare and potentially fatal twin-twin fetal transfusion syndrome just in time to refer Ms. De Mayo to another highly specialized center where a laser procedure was performed in utero to ensure proper blood supply to both twins. She subsequently delivered the babies at NBIMC. "Her heart was rock solid throughout the pregnancy and continues to be healthy," said Dr. Baran. "I told Dr. Nazir he could be comfortable doing whatever was necessary in the course of the birth, that her heart was strong."
Immediately following their birth, Melania, who weighed 4 pounds and 2 ounces, and Natalia, weighing 2 pounds and 13 ounces, were cared for in the NICU. Directed by Morris Cohen, MD, the NICU is at the core of a Regional Perinatal Center which provides highly specialized treatment to nearly 1000 premature and critically ill newborns each year and receives referrals from more than 15 hospitals in New Jersey and surrounding states.
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