Table S1 Diagnostic and procedure codes for transplantation International Classification of
Diseases 10th revision
Canadian Classification of Health Interventions Heart or lung T86.2, T86.3, Z76.803, Z76.805,
Z94.1-Z94.3
1.GR.85, 1.GT.85, 1.HY.85, 1.HZ.85
Liver T86.4, Z76.804, Z94.4 1.OA.85
Kidney T86.1, Z76.802, Z94.0 1.PC.85
Bone marrow or stem cell T86.0, Z76.800, Z76.801, Z94.80, Z94.83
-
Cornea Z94.7 1.CC.80.LA-XX-K, 1.CC.85,
1.CC.87.LA-XX-K
Conjunctiva or eyelid - 1.CS.80.LA-XX-K, 1.CS.84.LA-
XX-K, 1.CS.87.LA-XX-K, 1.CX.87.LA-XX-K, 1.CX.87.UD-
XX-K, 1.CX.87.VP-XX-K, 1.CX.88.UD-XX-K, 1.CX.88.VP-
XX-K
Skin Z94.5 -
Unspecified transplants T86.8, T86.9, Z76.806-Z76.809, Z94.6, Z94.81, Z94.82, Z94.88,
Z94.9
1.AE.85, 1.DF.85, 1.DK.85, 1.GJ.85, 1.NK.85, 1.NP.85, 1.OB.85, 1.OJ.85, 1.OK.85,
1.RB.85
Table S2 Number of children at risk of transplant by age and selected risk factor Age, years
0 2 4 6 8 10 12 14
Preterm birth
Yes 70 354 64 241 53 711 42 819 32 439 22 027 12 209 12 107 No
Neonatal intensive care unit admission
96 7 737 89 3 248 74 3 808 59 0 795 43 8 008 28 7 974 15 1 150 15 0 631
Yes 53 128 48 888 40 767 32 157 23 840 15 929 8771 8681 No
Congenital anomaly 98 5 247 90 8 841 75 6 975 60 1 660 44 6 799 29 4 252 15 4 758 15 4 224 Yes 67 502 61 823 51 266 40 608 30 680 20 853 11 397 11 322 No
Oligohydramnios 97 0 873 89 5 906 74 6 476 59 3 209 43 9 959 28 9 328 15 2 132 15 1 583 Yes 19 928 18 308 14 818 11 444 8338 5785 3583 3571 No 1 014 078 935 911 779 940 619 792 460 057 302 422 158 183 157 606
Table S3 Association of pregnancy outcomes with risk of childhood transplant by presence of congenital anomaly
Hazard ratio (95% confidence interval)a Heart or lung
transplant Liver transplant Kidney transplant
Bone marrow or stem cell transplant
Cornea transplant
Conjuctiva or
eyelid transplant Skin transplant Unspecified transplant Children with congenital
anomaly
Preterm birth 1.18 (0.27-5.08) 3.47 (0.75-16.12) 4.45 (1.78-11.15) 2.72 (1.11-6.62) 0.29 (0.04-2.16) 1.36 (0.16-11.74) 1.05 (0.29-3.84) 1.71 (0.47-6.20) Neonatal sepsis 7.70 (2.36-25.16) 6.51 (1.32-32.07) 4.63 (1.54-13.98) 1.65 (0.38-7.18) 1.78 (0.42-7.65) - 5.30 (1.36-20.68) - Complications of
prematurity
7.71 (2.30-25.89) 2.01 (0.39-10.43) 1.97 (0.45-8.75) 1.55 (0.36-6.60) 0.78 (0.10-6.32) 3.31 (0.39-28.12) 4.45 (1.09-18.16) 1.27 (0.17-9.82) Blood transfusion 20.16 (7.10-57.25) 7.60 (1.90-30.32) 4.49 (1.29-15.64) 2.31 (0.53-10.02) - - 6.15 (1.48-25.55) 1.86 (0.24-14.41) Intubation 11.94 (4.20-33.98) 5.31 (1.10-25.70) 7.95 (3.03-20.82) 3.11 (1.06-9.07) 1.43 (0.31-6.58) - 3.87 (0.95-15.77) 2.43 (0.54-10.85) Intensive care unit 13.63 (4.66-39.84) 9.98 (2.41-41.32) 8.15 (3.29-20.14) 3.35 (1.47-7.64) 1.64 (0.61-4.39) 2.83 (0.50-16.02) 1.31 (0.35-4.94) 3.92 (1.36-11.32)
Oligohydramnios 2.35 (0.33-17.00) - 29.87 (11.98-74.46) 2.84 (0.66-12.20) 1.53 (0.21-11.29) - - -
Children without congenital anomaly
Preterm birth 2.31 (0.69-7.74) 3.86 (2.04-7.30) 4.19 (1.53-11.48) 0.97 (0.48-1.95) 0.35 (0.06-2.17) 1.24 (0.16-9.57) - 0.70 (0.09-5.34) Neonatal sepsis 4.97 (1.13-21.79) 2.59 (0.80-8.38) - 2.72 (1.37-5.40) - 9.74 (2.21-42.84) - 4.71 (1.06-20.88) Complications of
prematurity
- - - - - - - -
Blood transfusion - - 23.47 (4.92-111.90) 3.14 (0.43-23.03) - - - -
Intubation 14.35 (3.81-54.10) - 6.09 (1.18-31.34) 1.62 (0.40-6.63) - - - -
Intensive care unit 3.27 (1.02-10.42) 2.77 (1.29-5.93) 2.02 (0.53-7.62) 1.88 (1.02-3.46) 1.48 (0.45-4.83) 4.11 (1.14-14.88) - 3.34 (0.99-11.26)
Table S4 Association of pregnancy outcomes with risk of childhood transplant by socioeconomic disadvantage
Hazard ratio (95% confidence interval)a Heart or lung
transplant Liver transplant Kidney transplant
Bone marrow or stem cell transplant
Cornea transplant Conjuctiva or eyelid
transplant Skin transplant Unspecified transplant Socioeconomic
disadvantage
Preterm birth 4.35 (0.90-21.02) 2.96 (0.86-10.18) 9.32 (2.46-35.38) 1.45 (0.44-4.71) 0.67 (0.15-2.94) 4.47 (0.47-42.81) - -
Neonatal sepsis - 6.05 (1.46-25.13) - 1.02 (0.13-7.80) - - - -
Complications of
prematurity - - - - - - - -
Blood transfusion - 14.71 (1.98-109.17) - 4.02 (0.46-35.35) - - - -
Intubation - 5.47 (0.73-40.93) 9.64 (1.05-88.84) - - - - -
Intensive care unit 9.06 (2.08-39.49) 5.61 (1.83-17.26) 7.94 (2.09-30.15) 3.27 (1.32-8.10) 2.90 (0.71-11.81) 17.39 (2.52-119.94) - - Congenital anomaly 4.45 (0.89-22.24) 0.93 (0.13-6.90) 22.91 (6.51-80.66) 1.98 (0.76-5.20) 5.82 (1.83-18.56) 15.62 (1.81-134.74) - 4.34 (0.87-21.69)
Oligohydramnios 13.86 (2.96-64.83) 3.22 (0.39-26.34) 24.60 (6.29-96.18) - - - - -
No socioeconomic disadvantage
Preterm birth 1.81 (0.55-5.97) 3.69 (1.81-7.54) 5.94 (2.68-13.16) 1.29 (0.72-2.31) 0.27 (0.03-2.79) 0.46 (0.03-6.93) 0.59 (0.13-2.55) 2.61 (0.89-7.67) Neonatal sepsis 11.23 (4.15-30.41) 2.99 (0.90-9.98) 6.50 (2.20-19.22) 3.18 (1.66-6.09) 2.43 (0.54-10.90) 6.18 (1.17-32.61) 2.44 (0.41-14.51) 3.12 (0.71-13.64) Complications of
prematurity 36.96 (10.72-127.44) 3.51 (0.57-21.67) 11.73 (2.34-58.87) 2.56 (0.62-10.61) 4.29 (0.50-37.13) 7.69 (0.66-89.57) 8.73 (1.84-41.41) 7.16 (0.97-53.08) Blood transfusion 65.47 (21.91-195.61) 4.62 (0.75-28.40) 35.56 (12.81-98.71) 3.42 (0.83-14.08) - - 11.69 (2.48-55.20) 9.75 (1.30-72.99) Intubation 32.72 (13.30-80.48) 1.89 (0.30-11.84) 28.45 (12.09-66.93) 4.21 (1.83-9.71) 5.10 (1.09-23.95) - 4.83 (0.96-24.21) 7.77 (1.82-33.23) Intensive care unit 11.33 (4.97-25.83) 3.09 (1.44-6.67) 10.28 (4.75-22.27) 2.15 (1.25-3.72) 2.82 (1.06-7.45) 3.47 (0.88-13.72) 0.93 (0.18-4.78) 9.27 (4.12-20.88) Congenital anomaly 13.11 (5.94-28.93) 2.36 (1.06-5.29) 11.52 (5.63-23.56) 2.32 (1.47-3.66) 17.46 (8.87-34.35) 4.78 (1.49-15.36) 3.77 (1.26-11.23) 12.64 (5.93-26.91) Oligohydramnios 2.22 (0.30-16.40) 1.15 (0.16-8.25) 15.76 (6.53-38.08) 1.85 (0.76-4.53) 1.56 (0.22-11.35) - - 1.97 (0.27-14.26)
aHazard ratio for maternal or neonatal exposures vs no exposure, adjusted for sex, multiple birth, maternal age, parity, maternal comorbidity, and time period.
Table S5 Joint association of specific birth outcomes with risk of childhood transplant
Hazard ratio (95% confidence interval)a Heart or lung
transplant Liver transplant Kidney transplant
Bone marrow or stem cell transplant
Cornea transplant
Conjuctiva or
eyelid transplant Skin transplant Unspecified transplant Neonatal sepsis 1.89 (0.66-5.40) 2.20 (0.72-6.71) 1.09 (0.31-3.84) 1.93 (0.98-3.80) 1.14 (0.20-6.61) 3.20 (0.50-20.54) 1.21 (0.37-4.01) 1.02 (0.17-6.08) Complications of
prematurity 0.64 (0.10-3.94) 0.38 (0.04-3.47) 0.31 (0.06-1.59) 0.41 (0.07-2.53) 1.91 (0.14-26.47) 5.14 (0.46-57.69) 5.82 (3.35-10.12) 0.86 (0.02-48.01) Blood transfusion 3.82 (0.91-15.98) 4.12 (1.44-11.75) 2.17 (0.61-7.72) 1.60 (0.20-13.12) - - 14.57 (12.64-16.78) 1.20 (0.04-35.50) Intubation 4.34 (1.15-16.34) 0.60 (0.23-1.55) 6.93 (2.38-20.23) 1.54 (0.42-5.64) 2.58 (0.33-20.29) - 1.37 (0.79-2.39) 1.61 (0.21-12.31) Intensive care unit 4.94 (1.76-13.88) 3.34 (1.62-6.90) 5.25 (2.44-11.27) 2.10 (1.26-3.51) 2.50 (0.98-6.37) 4.50 (1.43-14.22) 0.10 (0.06-0.17) 5.31 (2.38-11.89)
aHazard ratio for neonatal exposures vs no exposure, adjusted for sex, multiple birth, maternal age, parity, maternal comorbidity, socioeconomic disadvantage, time period, and other complications in the table.
Table S6 Association of pregnancy outcomes with type of bone marrow or stem cell
transplant
Hazard ratio (95% confidence interval)a Bone marrow or stem cell
transplant for oncologic tumor
Bone marrow or stem cell transplant for non-oncologic
pathology Birth outcome
Preterm birth 0.69 (0.31-1.53) 3.02 (1.52-6.01)
Low birth weight 1.00 (0.44-2.29) 2.88 (1.37-6.07)
Small-for-gestational age birth 0.73 (0.36-1.51) 1.38 (0.65-2.91)
Neonatal sepsis 1.39 (0.51-3.81) 5.13 (2.33-11.30)
Neonatal jaundice 0.89 (0.53-1.47) 1.94 (1.12-3.35)
Birth trauma 0.98 (0.43-2.24) 0.86 (0.27-2.74)
Respiratory disorder 1.03 (0.59-1.78) 1.59 (0.84-3.01)
Cardiovascular disorder 1.08 (0.53-2.22) 1.05 (0.38-2.91)
Metabolic disorders 0.76 (0.35-1.65) 2.59 (1.34-5.01)
Complications of prematurity 2.47 (0.58-10.52) -
Blood transfusion 1.62 (0.22-12.06) 8.24 (2.04-33.19)
Intubation 2.06 (0.63-6.72) 4.72 (1.48-15.04)
Intensive care unit 0.98 (0.44-2.18) 6.20 (3.46-11.10)
Congenital anomaly 2.16 (1.30-3.60) 2.17 (1.08-4.35)
Heart 1.76 (0.55-5.62) 5.11 (1.88-13.90)
Urinary 3.86 (1.57-9.45) 1.40 (0.20-9.57)
Eye, ear, nose - -
Musculoskeletal 2.12 (0.93-4.80) 3.36 (1.36-8.32)
Maternal complication
Gestational diabetes 0.71 (0.33-1.51) 1.51 (0.70-3.24)
Preeclampsia 0.52 (0.16-1.67) 1.14 (0.36-3.62)
Placental abruption 0.67 (0.17-2.72) 1.25 (0.31-5.10)
Placenta previa 2.42 (0.60-9.75) -
Premature rupture of membrane 0.99 (0.56-1.75) 0.78 (0.34-1.81) Antepartum hemorrhage 0.85 (0.27-2.66) 1.05 (0.26-4.30) Postpartum hemorrhage 1.10 (0.57-2.14) 1.52 (0.68-3.37)
Oligohydramnios 1.27 (0.40-4.04) 1.56 (0.39-6.27)
Polyhydramnios 0.55 (0.08-3.97) 3.27 (1.05-10.17)
Severe maternal morbidity 0.91 (0.29-2.88) -
Intensive care unit 1.83 (0.25-13.18) -
Cesarean delivery 0.92 (0.60-1.40) 0.96 (0.55-1.70)
aHazard ratio for maternal or neonatal exposures vs no exposure, adjusted for sex, multiple birth, maternal age, parity, maternal comorbidity, socioeconomic disadvantage, and time period.
Figure S1 Direct acyclic graph of pathways linking pregnancy outcomes with pediatric transplant
Figure S2 Cumulative incidence of superficial tissue transplantation between birth and 14 years