Data from a new study presented this week at The Liver Meeting® – held by the American Association for the Study of Liver Diseases and funded by the AASLD Foundation – found that less than two percent of pregnant women with cirrhosis had liver decompensation within one year of delivery, and their odds of decompensation is much lower than non-pregnant women with cirrhosis. The difference may relate to liver function at the time of conception or engagement in medical care.
Incidence of cirrhosis is rising, especially in women of childbearing age, but few studies have been conducted to evaluate the impact of pregnancy on liver decompensation in women with cirrhosis. To address this, researchers at Queen's University in Canada examined associations between liver-related health events and pregnancy in women with cirrhosis.
The evidence regarding pregnancy in patients with cirrhosis is sparse at best and what does exist is very dire. We felt that more research in the area was necessary to guide practitioners in their care for patients who achieve pregnancy, if they have cirrhosis and hopefully to reassure both the mothers and physicians about the expected course throughout their pregnancy."
Monica Mullin, MD, post-graduate trainee at Queen's University and the study's co-author
Chronic liver disease increasingly is seen in adolescent and young adult patients in North America, says Jennifer A. Flemming, MD, FRCP(C), MAS, assistant professor, Division of Gastroenterology and Department of Public Health Sciences at Queen's University, and the study's co-author. "Practitioners caring for women of child-bearing age are increasingly faced with providing counseling and recommendations not only on the ability to achieve pregnancy, but the safety of pregnancy for both the mother and baby. In Canada, longitudinal medical care is able to be captured and linked given the universal nature of our healthcare system. We had the unique ability to provide a more generalizable and contemporary description of liver-related events in a large cohort of pregnant women with cirrhosis which we anticipate will inform not only healthcare providers and patients but will be important for the development of clinical practice guidelines," says Dr. Flemming.
The population-based, retrospective matched cohort study used routinely collected healthcare data in Ontario from 2000 to 2017 to evaluate the association between pregnancy and liver decompensation. Women with a single-fetus pregnancy after their cirrhosis index date who carried their baby to at least 20 weeks of gestation were identified by linking mother-infant records. The researchers then matched pregnant women at the time of conception to two non-pregnant women with cirrhosis based on age (±5 years), cirrhosis etiology and socioeconomic status. Women with a previous transplant were excluded from the study. Control patients with a history of decompensation were also excluded; however, pregnant women with previous decompensation were included. The follow-up period was from time of conception to one year post-partum.
The study included 5,607 women with cirrhosis, including 1,869 pregnant and 3,738 non-pregnant women. Their median age was 31 years. Fifty-nine percent had a NAFLD/cryptogenic cirrhosis; 36 percent had viral hepatitis; and four percent had alcohol-related liver disease. A total of 33 (1.8 percent) of pregnant women in the study had a decompensation event compared to 349 (9.3 percent) of the non-pregnant women. Only five patients experienced liver decompensation before their delivery. After adjusting the results to consider co-existing illnesses the women might have been experiencing, pregnancy was associated with lower odds of liver decompensation, the study's authors found.
"Given that our results are from a large, contemporary, diverse population of women with cirrhosis, we hope that the low rate of complications we describe provides reassurance for pregnant women that the likelihood of a serious liver-related complication during the peri-partum period is low. The next steps in this study are to better define the maternal and fetal complications to provide an accurate overall estimate of risk for both the mother and child," says Dr. Flemming.
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