Pregnancy Outcomes in Women With Liver Cirrhosis: A National Prospective Cohort Study Using the UK Obstetric Surveillance System

Abstract

Objective

Describe maternal/fetal outcomes of pregnant women with cirrhosis.

Design

Prospective, national cohort study utilising the UK Obstetric Surveillance System between 1st June 2017 and 30th November 2020.

Setting

UK.

Population

Pregnant women with cirrhosis.

Methods

Rates of adverse perinatal outcomes were compared with published rates for uncomplicated pregnancies. The prediction of adverse pregnancy outcomes by albumin-bilirubin (ALBI) score was determined.

Main Outcome Measures

Maternal and fetal outcomes.

Results

52 eligible cases were reported (denominators represent available data for each outcome). Commonest causes included autoimmune hepatitis (12/50 (24.0%)), cholestatic disease (9/50 (18.0%)) and viral disorders (8/50 (18.0%)). Maternal decompensation occurred in seven women. Worst ALBI score predicted decompensation and maternal ICU admission (AUROC 0.80 (p = 0.03) and 0.81 (p = 0.03), respectively). Untreated varices were associated with increased rates of variceal bleed (p = 0.01). No women died. There were 42 live births (51.2% preterm), one stillbirth, and two neonatal deaths. The worst ALBI score in pregnancy predicted pre-term birth (AUROC 0.74 (p = 0.03)). Compared to a healthy population, women with cirrhosis were at increased risk of cholestasis in pregnancy (OR 29.4, 95% CI 13.8–61.6, p < 0.001), ICU admission (OR 42.5,95% CI 15.2–118.8, p < 0.001), pre-term birth (OR 13.2, 95% CI 7.1–24.4, p < 0.001), and babies with low birth weight (OR 12.0, 95% CI 6.5–22.0, p < 0.001), neonatal intensive care unit admission (OR 4.4, 95% CI 2.4–8.2, p < 0.001) and perinatal mortality (OR 15.8, 95% CI 4.9–51.3, p < 0.001).

Conclusion

Women with cirrhosis and their babies are at increased risk during pregnancy. The ALBI score predicts maternal decompensation, ICU admission, and pre-term birth.