title: Pregnancy outcomes in liver transplant patients, a population-based study.
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 US 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 nontransplant patients.
  
  
  RESULTS
  There were 7 288 712 deliveries and an estimated incidence of 2.1 LTs/100 000 deliveries over the nine-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, 95% CI: 1.0-3.5), anemia (OR 3.2, 95% CI: 2.1-4.9), thrombocytopenia (OR 27.5, 95% CI: 12.7-59.8) and genitourinary tract infections (OR 4.2, 95% CI: 1.8-9.8). Deliveries among women with LT had higher risks of cesarean section (OR 2.9, 95% CI: 2.0-4.1), postpartum hemorrhage (OR 3.2, 95% CI: 1.7-6.2) and blood transfusion (OR 18.7, 95% CI: 8.5-41.0). Fetal complications in LT patients included preterm delivery (OR 4.7, 95% CI: 3.2-7.0), intrauterine growth restriction (OR 4.1, 95% CI: 2.1-7.7) and congenital anomalies (OR 6.0, 95% CI: 1.1-32.0).
  
  
  CONCLUSIONS
  Although pregnancies in LT recipients are feasible, they are associated with a high rate of maternal and fetal morbidities. Close antenatal surveillance is recommended.
authors.affiliation: a Department of Obstetrics and Gynecology , Jewish General Hospital, McGill University , Montreal , Quebec , Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ghazali
authors.affiliation: b Center for Clinical Epidemiology and Community Studies, Jewish General Hospital , Montreal , Quebec , Canada , and.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Czuzoj-Shulman
authors.affiliation: b Center for Clinical Epidemiology and Community Studies, Jewish General Hospital , Montreal , Quebec , Canada , and.
authors.forename: Andrea R
authors.initials: AR
authors.lastname: Spence
authors.affiliation: c Section of Gastroenterology, Boston Medical Center, Granite Medical Group , Boston , MA , USA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Mishkin
authors.affiliation: a Department of Obstetrics and Gynecology , Jewish General Hospital, McGill University , Montreal , Quebec , Canada.|b Center for Clinical Epidemiology and Community Studies, Jewish General Hospital , Montreal , Quebec , Canada , and.
authors.forename: Haim A
authors.initials: HA
authors.lastname: Abenhaim
mesh_terms: D000328:Adult; D000013:Congenital Abnormalities / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D016031:Liver Transplantation; D016015:Logistic Models; D016555:Matched-Pair Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000209:etiology*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Liver; maternal; neonatal; obstetrics; transplantation