Cirrhosis worsens pregnancy outcomes

In pregnant women, liver cirrhosis appears to independently worsen perinatal outcomes, though liver-related complications appear to be rare, reports a recent study.

The researchers conducted a retrospective cohort analysis of 2,022 pregnant women with compensated cirrhosis, who were then matched to five controls each (n=10,110). Study endpoints included maternal and infant outcomes up to 6 weeks postpartum, and liver-related complications up to 1 year postpartum.

Multivariable log-binomial regression analysis found that cirrhosis significantly increased the likelihood of labour induction by 15 percent (relative risk [RR], 1.15, 95 percent confidence interval [CI], 1.03–1.28) and of preterm birth by 60 percent (RR, 1.60, 95 percent CI, 1.35–1.89).

In addition, pregnant mothers with cirrhosis were also more likely to give birth to infants who were large for their gestational age (RR, 1.24, 95 percent CI, 1.05–1.46) and had neonatal respiratory distress (RR, 1.20, 95 percent CI, 1.02–1.42).

In terms of complications, intrahepatic cholestasis of pregnancy was more than 10 times as likely to occur in cirrhotic mothers (RR, 10.64, 95 percent CI, 7.49–15.12); the risk of puerperal infections was also significantly elevated (RR, 1.32, 95 percent CI, 1.02–1.70).

Liver-related complications were rare in general, occurring in only 2 percent of all pregnant women sampled. The stratified prevalence rates, however, were significantly higher among those with hepatic decompensation than comparators with compensated cirrhosis (13 percent vs 1.2 percent; p<0.001).

“A multidisciplinary team of high-risk obstetrics specialists, neonatologists, and hepatologists is needed to coordinate care in pregnant women with cirrhosis during pregnancy and postpartum to optimize outcomes,” the researchers said.