Published online Nov 28, 2020. doi: 10.5500/wjt.v10.i11.320
Peer-review started: July 26, 2020
First decision: September 21, 2020
Revised: October 5, 2020
Accepted: October 20, 2020
Article in press: October 20, 2020
Published online: November 28, 2020
Processing time: 119 Days and 14.7 Hours
An increasing number of childbearing agewomen undergo liver transplantation (LT) in the United States. Transplantation in this patient subgroup poses a significant challenge regarding the plans for future fertility, particularly in terms of immunosuppression and optimal timing of conception. Intrapartum LT is only rarely performed as the outcome is commonly dismal for the mother or more commonly the fetus. On the other hand, the outcomes of pregnancy in LT recipients are favorable, and children born to LT recipients are relatively healthy. Counseling on pregnancy should start before LT and continue after LT up until pregnancy, while all pregnant LT recipients must be managed by amultidisciplinary team, including both an obstetrician and a transplant hepatologist. Additionally, an interval of at least 1-2 years after successful LT is recommended before considering pregnancy. Pregnancy-induced hypertension, pre-eclampsia, and gestational diabetes mellitus are reported more commonly during the pregnancies of LT recipients than in the pregnancies of non-transplant patients. As adverse fetal outcomes, such asmiscarriage, abortion, stillbirth, or ectopic pregnancy, may occur more often than in the non-transplant population, early planning or delivery either through a planned induction of labor or cesarean section is critical to minimize the risk of complications. No significant long-term physical or phycological abnormalities have been reported in children born to LT recipients.
Core Tip: An important number of childbearing age women undergo liver transplantation (LT) in the United States. Intrapartum LT is rarely performed as the outcome is commonly dismal for either the mother or the fetus. On the other hand, the outcomes of pregnancy in LT recipients are favorable, and children born to LT recipients are relatively healthy. An interval of at least 1-2 years after successful LT is recommended before considering pregnancy. As adverse fetal outcomes may occur more often than in the non-transplant population, early planning or delivery either through a planned induction of labor or cesarean section is crucial.