When Jessica learned she was pregnant just before Thanksgiving, she burst into tears of joy.
“I didn’t know that it could be a reality for me,” she said.
As a teenager Jessica Ramsammy was diagnosed with cardiomyopathy, a genetic disease that caused heart to fail when she was 19. She had a heart transplant in 2022. Although transplant patients have normal fertility rates, the risks involved in carrying a pregnancy are much higher.
Jessica, now 24, thought she wouldn’t be able to have children. That wasn’t actually the case, but and until relatively recently it was.
“For decades and decades, women like this were basically told that they couldn’t carry a pregnancy or couldn’t carry a pregnancy safely,” said Noel Strong, Jessica’s Ob-Gyn at Mount Sinai and a maternal fetal medicine specialist in high risk pregnancies. “Even without medical complications, pregnancy is one of the most complex, risky health situations someone can put themselves through,” Strong said.
Transplant patients are at higher risk for pregnancy complications including pre-eclampsia, high blood pressure, pre-term birth and fetal abnormalities.
“In general pregnancy after a heart transplant carries a lot of risks with it, to the baby as well as the mother,” said Maya Barghash, Jessica’s transplant surgeon, an advanced heart failure and transplant cardiologist at Mount Sinai Fuster Heart Hospital. “It has to be planned because of all of the different medications that can affect the development of the baby.”
After an organ transplant, recipients must take medication that suppresses the immune system for the rest of their life, so the immune system doesn’t recognize the organ as a foreign body and attack it. Those same drugs can inhibit the mother’s body connecting with the fetus, leading to complications.
There are also risks particular to heart transplants. “Sometimes after rejection, the heart can become weak, and that can make it even more dangerous to carry through the pregnancy, because the heart has to be able to provide enough oxygen and blood to the both the baby and the mother,” Barghash said.
But the risks can be managed with proper care. In a recent analysis, researchers found that about 75 percent of heart transplant patients were able to give birth to living children. “There’s so many technologic advances now. That’s another reason why planning is so important,” Barghash said.
As she went through her pregnancy, Jessica met with her team at Mount Sinai every two weeks to make sure she and the baby were healthy. Because Jessica’s heart condition was genetic, there was also a fifty percent chance her baby would have it, too. Fortunately, an echocardiogram showed that the fetus didn’t have the condition that caused Jessica’s heart to fail.
When the results came back showing her baby’s heart was normal, Jesica became even more determined to become a mother.
“I feel like I’m lucky to have this child. I’m lucky to even know that I’m pregnant,” she said.
Towards the end of her pregnancy Jessica had a moment of panic when she stopped being able feel her baby moving inside of her. “Normally, he kicks a lot, and that day, he didn’t. He wasn’t doing much of anything, so I just got really worried,” she recalled.
She rushed to Mount Sinai. Shane was ultimately okay, and Jessica was able to give birth at full term via C-section three weeks later.
Shane was born weighing five pounds and one ounce on April 24. Jessica is supported by her partner, mom and grandmother, and numerous other relatives.
“This is a fourth generation baby, because I have my grandma with me,” Jessica said. “I’m very lucky to be able to have them all around for my first child.”
She is also grateful for the support of another person: the 12-year-old girl whose heart now beats in her chest. “I feel very connected to this heart,” she said. “They couldn’t tell me much about her for confidentiality reasons, but I still want to know how the family is, and I wish they could know that, hey, like, I’m still alive. Everything went well. I had a whole baby.”