| dc.description.abstract | Abstract Background: Pregnancies following maternal organ transplantation have been reported for several decades. The first successful pregnancy following maternal renal transplantation was described in 1963. Since that time, there have been numerous successful pregnancies in various types of transplant recipients. However, pregnancy in organ transplanted women can impose additional risk to the mother, child and transplanted organ. A retrospective cohort study based on all first deliveries in kidney transplanted women in Norway between 1969 and 2013 showed high rates of maternal and neonatal complications, such as preeclampsia, preterm delivery and low birthweight. One of the major post-natal concerns about the offspring’s health is related to the use of immunosuppressive therapy during pregnancy. Relatively little data are available on the outcome of the children of these patients. Therefore, the aim of this study was to perform a systematic literature review of the overall health outcome of children born to mothers who are organ transplant recipients. Methods: A systematic search in the database Pubmed was conducted in December 2017. Pregnancy following organ transplantation, pregnancy and neonatal outcome after organ transplantation, and offspring or children born to mothers following organ transplantation were identified and included in the study. Results: The search resulted in 317 articles. Twenty-one of these included pregnancy outcomes following organ transplantation and the potential risk of the offspring. Most of the studies used female renal transplant recipients and their children as a study population. The impact on the neurological development, intelligence level, rate of infections, vaccine response and congenital malformations among children born to female organ transplant recipients have been studied by several different groups. The neurological development and the intelligence level were shown to be similar to the general population. Two studies displayed a higher rate of respiratory infections and hospital admissions among children born to mothers following organ transplantation. One study showed low levels of serum IgG in newborns with organ transplanted mothers. Another study showed a significant reduction of B cells in infants born to female renal recipients. However, after 8 months most immune alterations were no longer observed. Several reports on congenital malformations have been made on the use of mycophenolate mofetil as immunosuppressive medication during pregnancy. One study showed a moderately increased risk of congenital malformations in infants exposed to azathioprine in utero, specifically ventricular/atrial septal defects. Overall, the rate of preterm birth and low birthweight were higher among the children of the organ transplanted women. Conclusion: Pregnancies following organ transplantation are at high risk of complications such as preeclampsia, preterm birth and low birthweight. There is a risk of teratogenicity especially linked to the use of mycophenolate mofetil and a theoretical risk of teratogenicity with other immunosuppressive agents. Studies have shown an increased risk of respiratory infections and hospital admissions among children born to female organ transplant recipients. The morbidity can be a consequence of short gestation and prematurity. Despite the high rate of preterm delivery and low birthweight, the overall health outcome of the children is promising. However, caution is warranted due to small study samples. Prospective studies of children born to organ transplant recipients with long-term follow-up are warranted. | eng |