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Objective To evaluate pregnancy after heart or heart-lung transplantation in France.Design A questionnaire survey of all French centres performing heart and heart-lung transplants provided an exhaustive registry on pregnancy after transplantation.Methods A questionnaire was sent to 36 centres. Anonymous reports on transplantation and subsequent pregnancies between 1984 and 1996 were analysed. ResultsOf 1290 heart and 120 heart-lung transplantation performed during the study period, 10 pregnancies (seven after heart transplantation and three after heart-lung transplantation) were reported in nine women who were delivered of 11 infants. High blood pressure complicated nine pregnancies and severe pre-eclampsia occurred in two. One woman developed Kaposi sarcoma of the cervix. Delivery at 35 weeks gestation (27-39) was by caesarean section in 50% cases. Mean birthweight was 1990 g (700-28808) and 50% of the infants had a birthweight < tenth centile. One infant developed cardiomyopathy as a condition inherited fiom her mother, and congenital hepatitis B was diagnosed in another.Conclusions Pregnancy after heart and heart-lung transplantation is feasible and can be successful, but this should be planned when cardiac and respiratory functions are stable. Adequate obstetrical and genetic counselling should be provided.