J Matern Fetal Neonatal Med. 2016 Apr 4:1-17. [Epub ahead of print]

Pregnancy outcomes in liver transplant patients, a population based study.

Ghazali S¹, Czuzoj-Shulman N², Spence AR², Mishkin DS³, Abenhaim HA^1,2.

Abstract

OBJECTIVE:

To determine the incidence of pregnancy in liver transplant (LT) patients in a large population-based cohort and to determine the maternal and fetal risks associated with these pregnancies.

METHODS:

We conducted an age-matched cohort study using the United States Healthcare and Utilization project-Nationwide Inpatient Sample from 2003-2011. We used unconditional logistic regression, adjusted for baseline characteristics, to estimate the likelihood of common obstetric complications in the LT group compared with age-matched non-transplant patients.

RESULTS:

There were 7,288,712 deliveries and an estimated incidence of 2.1 LTs/100,000 deliveries over the 9 year study period. LT patients had higher rates of maternal complications including hypertensive disorders (OR 6.5, 95% CI 4.4-9.5), gestational diabetes (OR 1.9, 1.0-3.5), anemia (OR 3.2, 2.1-4.9), thrombocytopenia (OR 27.5, 12.7-59.8), and genitourinary tract infections (OR 4.2, 1.8-9.8). Deliveries among women with LT had higher risks of cesarean section (OR 2.9, 2.0-4.1), postpartum hemorrhage (OR 3.2, 1.7-6.2), and blood transfusion (OR 18.7, 8.5-41.0). Fetal complications in LT patients included preterm delivery (OR 4.7, 3.2-7.0), intrauterine growth restriction (OR 4.1, 2.1-7.7), and congenital anomalies (OR 6.0, 1.1-32.0).

CONCLUSION:

Although pregnancies in LT recipients are feasible, they are associated with a high rate of maternal and fetal morbidities. Close antenatal surveillance is recommended.