Data-driven insights and solutions for the health and human resource crisis in Canada
Myran D, Gibb M, Kendall C, Simpson A, Sood M, Backman C, Tranmer J, Tanuseputro P. Healthc Q. 2024; 27(2).
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.
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.
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