title: Pregnancy outcomes in liver and cardiothoracic transplant recipients: a UK national cohort study.
abstract: BACKGROUND
  There are an increasing number of reports of pregnancy in transplant recipients but many questions remain regarding the effect of the transplant on pregnancy outcome, the pregnancy on the graft and the medication on the fetus. The majority of studies reporting outcomes in transplant recipients have focused on women with kidney transplants, and have included retrospective, voluntary registries or single centre studies.
  
  
  METHODS
  The UK Obstetric Surveillance System (UKOSS) was used to prospectively identify all pregnant women with a liver or cardiothoracic transplant in the United Kingdom, between January 2007 and January 2012. Data were collected on demographics, transplant characteristics, immunosuppression regimens, antenatal care, maternal, graft and neonatal outcomes. In an exploratory analysis, we tested for associations between "poor fetal outcome" and medications used before or during pregnancy.
  
  
  CONCLUSIONS
  We report 62 pregnancies in 56 liver transplant recipients and 14 pregnancies in 14 cardiothoracic transplant recipients (including 10 heart, three lung and one heart-lung recipient). Liver transplant recipients, in comparison to cardiothoracic, had similar livebirth rates (92% vs. 87%) but better fetal outcomes (median gestational age 38 weeks vs. 35 weeks; median birthweight 2698 g vs. 2365 g), fewer caesarean deliveries (47% vs. 62%), fewer maternal intensive care (ICU) admissions (19% vs. 29%) and fewer neonatal ICU admissions (25% vs. 54%). Nine women (12%) were taking mycophenolate mofetil at conception, which was associated with adverse fetal outcomes. Pregnancy in transplant recipients may have successful outcomes, but complication rates are high, emphasising the role of pre-conception counselling and further research into the long-term effect on maternal and graft survival rates.
authors.affiliation: National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom.
authors.forename: Olaa
authors.initials: O
authors.lastname: Mohamed-Ahmed
authors.affiliation: Division of Women's Health, King's College London, Women's Health Academic Centre, King's Health Partners, United Kingdom ; Obstetric Medicine, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Cathy
authors.initials: C
authors.lastname: Nelson-Piercy
authors.affiliation: Division of Women's Health, King's College London, Women's Health Academic Centre, King's Health Partners, United Kingdom.
authors.forename: Kate
authors.initials: K
authors.lastname: Bramham
authors.affiliation: National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom.
authors.forename: Haiyan
authors.initials: H
authors.lastname: Gao
authors.affiliation: National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Kurinczuk
authors.affiliation: Institute for Women's Health, University College London, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Brocklehurst
authors.affiliation: National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom.
authors.forename: Marian
authors.initials: M
authors.lastname: Knight
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D016027:Heart Transplantation / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D016040:Lung Transplantation / Q000379:methods / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012042:Registries; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000534:rehabilitation / Q000706:statistics & numerical data; D066027:Transplant Recipients / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult