Increasing numbers of women with thoracic transplants are planning and continuing pregnancies. However, pregnancy outcomes and risks to the mother and baby have not been systematically assessed. MEDLINE, EMBASE, and Cochrane Central were searched from their inception to January 2018, to identify studies reporting outcomes on 3 or more pregnancies following thoracic transplants. Pooled incidences were calculated using a random-effect meta-analysis. Risk-of-bias was assessed using the Joanna Briggs Checklist for case series. Subgroup analysis was conducted based on the organ transplanted. Of the 3,658 records identified, 12 studies were included that reported on 385 pregnancies in 272 thoracic transplant recipients. Maternal complications included mortality (pooled incidence 0.5% [95% confidence intervals 0, 1.1%] during pregnancy and 15.4% [10.4, 20.3%] during follow-up, which ranged between 3 and 7 years), graft rejection (7.4% [4.2, 10.5%]), hypertensive disorders of pregnancy [26.6% [13.7, 39.6%]), and cesarean deliveries (41.4% [33.4, 48.7%]). Maternal mortality was more common in recipients of lung vs heart transplants (41.4% [23.4, 59.3] vs 10.8% [5.9, 15.8]), respectively. Although 78.4% (69.8, 86.9%) of the pregnancies resulted in live births, 51.2% (31, 71.3%) were born preterm and neonatal deaths occurred in 3.4% (1.3, 5.6%). Congenital anomalies affected 4.3% (1.8, 6.8%) of the newborns. Although few maternal deaths occurred during pregnancy, in keeping with median survival data, delayed mortality for thoracic transplant recipients remains high. Despite the high numbers of live births, these pregnancies continue to be at risk for hypertensive disorders, graft rejection, preterm birth, and neonatal mortality. Prospectively gathered data from international registries should supplement these findings to better inform clinical counseling and practice.

中文翻译：

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心胸移植妇女的妊娠结局：系统评价和荟萃分析。

越来越多的接受胸部移植手术的女性正在计划和继续怀孕。然而，尚未系统地评估妊娠结局和母婴风险。从 MEDLINE、EMBASE 和 Cochrane Central 开始到 2018 年 1 月进行了搜索，以确定报告了 3 次或更多胸部移植术后妊娠结局的研究。使用随机效应荟萃分析计算汇总发生率。使用案例系列的 Joanna Briggs 检查表评估偏倚风险。基于移植的器官进行亚组分析。在确定的 3,658 条记录中，包括 12 项研究，这些研究报告了 272 名胸部移植受者的 385 次怀孕。孕产妇并发症包括死亡率（合并发生率 0.5% [95% 置信区间 0, 1.1%] 怀孕期间和 15.4% [10.4, 20.3%] 在随访期间（3 至 7 年）、移植排斥（7.4% [4.2, 10.5%]）、妊娠高血压疾病 [26.6% [13.7, 39.6%]）和剖宫产（41.4 % [33.4, 48.7%])。肺移植受者与心脏移植受者的产妇死亡率分别更高（分别为 41.4% [23.4, 59.3] 和 10.8% [5.9, 15.8]）。虽然 78.4% (69.8, 86.9%) 的妊娠导致活产，但 51.2% (31, 71.3%) 为早产，3.4% (1.3, 5.6%) 发生新生儿死亡。先天性异常影响了 4.3% (1.8, 6.8%) 的新生儿。尽管在怀孕期间很少发生孕产妇死亡，但与中位生存数据一致，胸部移植受者的延迟死亡率仍然很高。尽管活产数量很多，但这些妊娠仍然面临高血压疾病、移植排斥、早产和新生儿死亡率。从国际注册处前瞻性收集的数据应补充这些发现，以更好地为临床咨询和实践提供信息。