Outcomes of Pregnant Women With Cirrhosis and Their Infants in a Population-Based Study.

Abstract

BACKGROUND & AIMS:

The incidence of cirrhosis is increasing among women of childbearing age. Contemporary outcomes of pregnant women with cirrhosis and their infants, as well as liver-related complications, have not been described in North America, to our knowledge. We investigated the association between cirrhosis and perinatal outcomes and evaluated perinatal liver-related events.

METHODS:

We performed a retrospective cohort study using population-based administrative health care data from Ontario, Canada (2000-2017). We identified pregnant women with compensated cirrhosis (n = 2022) using validated case definitions and routine mother-infant linkage; the women were matched to 10,110 pregnant women in the general population (1:5) based on birth year and socioeconomic status. Maternal and infant outcomes up to 6 weeks postpartum and liver-related complications up to 1 year postpartum were evaluated by using multivariate log-binomial regression.

RESULTS:

After we adjusted for demographic and metabolic risk factors, cirrhosis was independently associated with intrahepatic cholestasis of pregnancy (relative risk [RR], 10.64; 95% confidence interval [CI], 7.49-15.12), induction of labor (RR, 1.15; 95% CI, 1.03-1.28), puerperal infections (RR, 1.32; 95% CI, 1.02-1.70), preterm birth (RR, 1.60; 95% CI, 1.35-1.89), infants who were large for gestational age (RR, 1.24; 95% CI, 1.05-1.46), and neonatal respiratory distress (RR, 1.20; 95% CI, 1.02-1.42). Fewer than 2% of pregnant women with cirrhosis had liver-related complications, but these occurred in a significantly higher proportion of women with a history of hepatic decompensation (13%) than women with compensated cirrhosis (1.2%) (P < .001).

CONCLUSIONS:

In a population-based study, we found that cirrhosis is an independent risk factor for adverse perinatal outcomes. However, liver-related complications are rare. Multidisciplinary teams are needed to coordinate care for pregnant women with cirrhosis during pregnancy and postpartum to optimize outcomes.

• Authors: Jennifer A Flemming, Monica Mullin, Jacquie Lu, Monika A Sarkar, Maya Djerboua, Maria P Velez, Susan Brogly, Norah A Terrault
• Journal: Gastroenterology (Gastroenterology) Vol. 159 Issue 5 Pg. 1752-1762.e10 (11 2020) ISSN: 1528-0012 [Electronic] United States
• PMID: 32781083 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2020 AGA Institute. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Cholestasis, Intrahepatic (epidemiology)
• Databases, Factual
• Female
• Humans
• Incidence
• Labor, Induced
• Live Birth
• Liver Cirrhosis (diagnosis, epidemiology, mortality, therapy)
• Ontario (epidemiology)
• Pregnancy
• Pregnancy Complications (diagnosis, epidemiology, mortality, therapy)
• Pregnancy Outcome
• Premature Birth (epidemiology)
• Prognosis
• Respiratory Distress Syndrome, Newborn (epidemiology)
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Time Factors