Study: Liver transplants linked to worse pregnancy outcomes
Tuesday, December 17, 2019
Pregnant women who received liver transplants are at higher risk for pregnancy-related complications, according to data presented at the American College of Gastroenterology Meeting.
“As more women of childbearing age undergo transplantation and subsequently experience pregnancy, issues regarding complications and the effect on outcomes will only become more relevant,” said Dr. Lindsay A. Sobotka, a fellow at The Ohio State University Wexner Medical Center in Healio Gastroenterology and Liver Disease. “It is crucial to recognize factors that worsen patient and hospital outcomes to reduce patient morbidity and healthcare costs.”
For the study, the Ohio State research team analyzed a large inpatient sample of data from pregnant women who received care between 2005 and 2013.
Pregnant women who had undergone a liver transplant were more likely than those who did not to miscarry or have pregnancy-related complications, such as intrauterine growth restriction, postpartum hemorrhage, hypertension, preeclampsia or venous thromboembolism.
Liver transplant recipients were also more likely to require a cesarean delivery instead of a vaginal birth. The data did not indicate an increased risk of mortality for female transplant recipients.
“These results continue to highlight that liver transplant patients can experience pregnancy without a significant risk for mortality,” Sobotka said. “While there has previously been concerns about transplant patients experiencing pregnancy given fear of complications and outcomes, we continue to provide evidence that pregnancy should not be advised against in this patient population.”
Statistics indicates approximately 3,500 women of childbearing age have transplants each year. An additional 750 girls under 17 who may become pregnant later in life have transplants each year.
While this most recent study indicates an increased risk of complications among liver transplant recipients, the long-standing opinion is that women who have undergone any sort of solid organ transplantation can carry a pregnancy to term. In “Pregnancy After Solid Organ Transplantation: A Guide for Obstetric Management,” authors write women should wait at least a year before attempting to conceive in order to mitigate risks.
Women's health should also be closely monitored by a multidisciplinary team during pregnancy. Specifically, hypertension, diabetes and infection should be closely followed. Immunosuppressants should also be continued during pregnancy to avoid allograft rejection.
Dr. Carlos Romero-Marrero of the Cleveland Clinic says the Ohio State study is important since it looks specifically at liver transplant recipients.
"A significant finding is that there was an increase in pregnancy-related complications – more than double compared with normal patients, while the survival was not affected. The results of this study emphasize the importance of the multidisciplinary care in patients who become pregnant after liver transplant. These patients should be treated as high-risk pregnancies and a good communication between the obstetrician, the hepatologist and the perinatologist is helpful in maximizing outcomes," he said.
"Ultimately, post liver transplant patients planning to conceive should discuss with their transplant providers about the right timing of conception. We usually recommend patients to wait at least 1 year after liver transplant for conception. We also recommend having a good liver allograft function, being on a stable immunosuppression regime and having well controlled comorbidities. Once pregnant, post-liver transplant patients should be followed closely by a multidisciplinary team."
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