612: Severe maternal morbidity among women with solid organ transplants: A population-based study

Abstract

Objective: To determine the frequency of deliveries to women with a solid organ transplant, and to quantify associated severe maternal morbidity and mortality. Study Design: We carried out a retrospective cohort study of all hospital live births at >=20 weeks’ gestation in Canada (excluding Quebec) between 2003 and 2012 with data obtained from the Canadian Institute for Health Information. Severe maternal morbidity was defined both as a composite outcome and also as specific severe maternal morbidity using International Classification of Diseases (ICD-10CA) diagnosis codes and also Interventions codes. Logistic regression was used to obtain adjusted odds ratios (AOR) and 95% confidence intervals (CI) after adjustment for maternal age, parity, plurality, and use of assisted reproduction. Results: There were 3,587,840 deliveries included in the study population of which 296 were to women with a solid organ transplant (8.3 per 100,000). The most common transplant subtypes included kidney and liver transplants. Composite severe maternal morbidity rates were 125.0 (95% CI 88.0-172.3) and 9.4 (95% CI 9.3-9.5) per 1,000, respectively, among women with and without a solid organ transplant. The median length of hospital stay for women with and without a solid organ transplant was 8 and 3 days, respectively, while the frequency of prolonged hospital stay (>7 days) was 22.3% and 1.8%, respectively. Regression analysis showed that women with solid organ transplants had substantially higher rates of composite severe maternal morbidity (AOR 14.6, 95% CI 10.1-21.3). Severe morbidity among women with organ transplants included severe preeclampsia or HELLP syndrome (AOR 5.9, 1.9-18.4), eclampsia (AOR 16.3, 95% CI 5.2-0.9), acute renal failure (AOR 231.3, 95% CI 140.1-381.8), acute fatty liver with red cell or plasma transfusion (AOR 38.5, 95% CI 5.3-277.8), hepatic failure (AOR 154.3, 95% CI 21.3-999.9) and cardiac conditions (Table 1). Conclusion: Severe maternal morbidity and hospitalization patterns show that women with solid organ transplants have serious life-threatening pregnancy-related challenges. Absolute and relative severe morbidity rates from this study will be useful for formulating standard of care guidelines, and for counselling and managing pregnant women with solid organ transplants. [Figure presented]