Outcomes of pregnant women with cirrhosis and their infants in a population-based study
Flemming JA, Mullin M, Lu J, Sarkar MA, Djerboua M, Velez MP, Brogly S, Terrault NA. Gastroenterology. 2020; 159(5):1752-62.e10. Epub 2020 Aug 8. DOI: https://doi.org/10.1053/j.gastro.2020.07.052
Background and Aims — The incidence of cirrhosis is increasing among women of childbearing age. Contemporary outcomes of pregnant women with cirrhosis and their infants, and liver-related complications, have not been described in North America. 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 healthcare 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 post-partum and liver-related complications up to 1 year post-partum were evaluated 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% 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), pre-term delivery (RR, 1.60; 95% CI, 1.35–1.89), infants that 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 post-partum, to optimize outcomes.