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To systematically review the literature reporting pregnancy outcomes in cardiothoracic transplant recipients and to estimate the incidence of maternal, fetal and neonatal complications in these women.
A search strategy was designed for MEDLINE, EMBASE, and Cochrane Central from inception to July 2016 to identify studies reporting outcomes in three or more pregnancies following cardiothoracic transplant. Pooled incidence of maternal outcomes (maternal mortality, organ rejection and preeclampsia) and fetal and neonatal outcomes (livebirth, fetal anomalies, preterm births and fetal growth restriction) were calculated using random-effect meta-analysis and reported per 100 pregnancies with 95% confidence intervals (CI). Risk of bias was determined using the Institute of Health Economics’ Quality Appraisal Tool for Uncontrolled Observational Studies. Subgroup analysis was conducted based on transplanted organ and sensitivity analysis based on the studies’ risk of bias.
A total of 3,002 records were identified, 172 full texts reviewed and 19 studies included. The included studies reported on a total of 406 pregnancies in 301 cardiothoracic transplant recipients (183 heart, 42 heart-lung, and 76 lung). Maternal mortality was 2.5%, (0.2-4.7%), organ rejection occurred in 10.4% (6.4-14.4%) and preeclampsia in 16.3% (10.6-21.9%). Live births were reported in 77.1% (69.8-84.9%) pregnancies of which 37.0% (25.7-48.2%) resulted in preterm births. Compared with heart transplant recipients, lung transplant recipients were more likely to experience preterm births [50.3% (35.5-65.0) vs. 39.8% (30.7-49.0)] and organ rejection [18.5% (7.8-29.3) vs. 8.5% (2.0-15.0)]. No other significant differences in the pregnancy outcomes were observed in subgroup meta-analyses by transplanted organ.
With appropriate multidisciplinary care, women with cardiothoracic transplants can have successful pregnancies with high livebirth rates. Although maternal mortality is rare, these women are at risk for organ rejection, preeclampsia and preterm births.