Impact of Pre-Pregnancy Body Mass Index on Pregnancy and Perinatal Outcomes in Liver Transplant Recipients: A Retrospective Cohort Study

<b>Background</b>: Pre-pregnancy overweight and obesity are established risk factors for adverse maternal and perinatal outcomes in the general obstetric population. However, data regarding their impact in female liver transplant recipients remain limited. This study aimed to evaluate the association between pre-pregnancy body mass index (BMI) and pregnancy-related complications and neonatal outcomes in this high-risk cohort. <b>Methods</b>: A retrospective cohort analysis was conducted on pregnancies in liver transplant recipients who delivered between 2001 and 2022 at a single tertiary referral center. Participants were stratified into two groups based on pre-pregnancy BMI: normal weight (18.5-24.9 kg/m²) and overweight/obese (≥25 kg/m²). Maternal characteristics, pregnancy complications, and perinatal outcomes were compared using appropriate statistical methods, with significance set at <i>p</i> < 0.05. <b>Results</b>: Among 72 pregnancies included in the analysis, 48 (66.7%) were in women with normal BMI, and 24 (33.3%) were in those with an elevated BMI. No statistically significant differences were observed in gestational age at delivery, neonatal birth weight, Apgar scores, or incidence of preterm birth. Although pregnancy-induced hypertension and cesarean delivery were more prevalent among overweight/obese individuals, these differences did not reach statistical significance (PIH: 28% vs. 10.4%, <i>p</i> = 0.112; cesarean delivery: 76% vs. 64.6%, <i>p</i> = 0.465). <b>Conclusions</b>: In conclusion, pre-pregnancy overweight and obesity were not significantly associated with adverse obstetric or neonatal outcomes in liver transplant recipients. Nevertheless, the observed trends suggest a potential predisposition to hypertensive disorders (PIH: 28% vs. 10.4%, <i>p</i> = 0.112), underscoring the importance of individualized preconception counseling and weight optimization strategies in this high-risk patient population.