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From the Journals

Organ Transplant Linked to Higher Risks of Adverse Pregnancy Outcomes

Solid organ transplant recipients are at heightened risk for preeclampsia, preterm birth, and low birth weight during pregnancy, according to findings from a new study.

Conexiant

Pregnancies in solid organ transplant recipients carry a 5.83-fold increased risk of preeclampsia, a 6.65-fold increased risk of preterm birth before 37 weeks, and a 6.51-fold increased risk of low birth weight (under 2,500 grams), according to findings from a recently published study.

The systematic review and meta-analysis—results of which were published in JAMA Network Open—investigated the incidence of adverse pregnancy outcomes in solid organ transplant recipients. The analysis included 22 studies involving 93,565,343 pregnancies; 4,786 occurred in recipients of kidney, liver, heart, or lung transplants.

The findings demonstrated an increased risk of preeclampsia (adjusted odds ratio [aOR] = 5.83; 95% confidence interval [CI] = 3.45-9.87), preterm birth before 37 weeks (aOR = 6.65; 95% CI = 4.09-12.83), and low birth weight (aOR = 6.51; 95% CI = 2.85-14.88) in transplant recipients compared with pregnancies occurring in participants who had not undergone a transplant.

The findings indicated that although there is an elevated risk of preterm birth, most women gave birth during the early term period. The difference in gestational age between transplant recipients and non-transplant controls was about 3 weeks. Additionally, pregnancies in transplant recipients were associated with a notably higher likelihood of cesarean delivery (aOR = 3.30; 95% CI = 2.13-5.11). 

The study also reported a pooled incidence of acute allograft rejection during pregnancy of 2.39% (95% CI = 1.20%-3.96%); about 65% of these rejections occurred in kidney transplant recipients and about 35% occurred in liver transplant recipients. The incidence of allograft loss during pregnancy was 1.55% (95% CI = 0.05%-4.44%); nine episodes of allograft loss during pregnancy occurred in women with kidney transplants.

The study authors concluded, "Pregnancies in solid organ transplant recipients, compared with pregnancies in individuals without an organ transplant, were significantly associated with adverse pregnancy outcomes. The overall rate of allograft rejection and loss during pregnancy was low."

The researchers reported no conflicts of interest.