Liver cirrhosis ups risks of adverse pregnancy outcomes

The presence of liver cirrhosis is detrimental in pregnant women, being associated with elevated risks of maternal mortality as well as obstetric and foetal complications, a study has found.

Researchers conducted a systematic literature review and meta-analysis on maternal, foetal and obstetric complications among pregnant women with liver cirrhosis vs controls. They searched multiple online databases for relevant studies.

The initial search yielded 3,118 unique papers, of which 11 studies met the inclusion criteria for the systematic review and seven in the meta-analysis. The total number of pregnancies with and without liver cirrhosis (case and control) included in the meta-analysis was 2,685 and 4,283,173, respectively.

Eight studies reported on maternal death, which ranged from 0 percent to 7.8 percent. In total, there were 25 deaths recorded in 2,794 cases as opposed to 197 in 2,024,845 controls (0.89 percent vs 0.010 percent), translating to an 80-fold higher rate among pregnant women with cirrhosis (odds ratio [OR], 80.2, 95 percent CI, 27.3–235.1; p<0.0001). The overall maternal mortality rate was 0.89 percent, with most cases attributed to variceal haemorrhage (70 percent) that occurred during vaginal delivery.

Pooled data showed that the presence of liver cirrhosis during pregnancy was associated with a greater likelihood of adverse outcomes, including preterm delivery (OR, 6.7, 95 percent CI, 5.1–9.1), caesarean section (OR, 2.6, 95 percent CI, 1.7–3.9), pre-eclampsia (OR, 3.8, 95 percent CI, 2.2–6.5), and small-for-gestational-age neonates (OR, 2.6, 95 percent CI, 1.6–4.2). Subgroup analyses could not be conducted.

Large international prospective studies are required to determine the risk factors for unfavourable outcome.