Monica Mullin, Maya Djerboua, Monika Sarkar, Jacquie Lu, Maria P Velez, Susan Brogly, Norah A Terrault, Jennifer A Flemming
{"title":"Pregnancy Is Not Associated with an Increased Risk of Decompensation, Transplant, or Death in Compensated Cirrhosis.","authors":"Monica Mullin, Maya Djerboua, Monika Sarkar, Jacquie Lu, Maria P Velez, Susan Brogly, Norah A Terrault, Jennifer A Flemming","doi":"10.1155/2022/9985226","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aims: </strong>Childbirth in women with cirrhosis is increasing and associated with a higher risk of perinatal outcomes compared to the general population. Whether pregnancy influences the risk of liver-related events compared to nonpregnant women with cirrhosis is unclear. This study evaluates the association between pregnancy and liver-related outcomes in women with compensated cirrhosis. <i>Approach and Results</i>. Population-based retrospective matched cohort study in Ontario, Canada, using routinely collected healthcare data. Pregnant women with compensated cirrhosis and without prior history of decompensation between 2000 and 2016 were identified and matched to nonpregnant women with compensated cirrhosis on age, etiology of cirrhosis, and socioeconomic status in a 1 : 2 ratio. The association between pregnancy and the composite outcome of nonmalignant decompensation, liver transplant (LT), and death up to two years after cohort entry was estimated using the multivariate Cox proportional hazard regression adjusting for potential confounders. Overall, 5,403 women with compensated cirrhosis were included (1,801 pregnant; 3,602 nonpregnant; median age 31 years (IQR 27-34); 60% nonalcoholic fatty liver disease, 34% viral hepatitis). After two years of follow-up, only 19 (1.1%) pregnant women had a liver-related event compared to 319 (8.9%) nonpregnant women. Pregnant women with compensated cirrhosis had a lower hazard of a liver-related event compared to nonpregnant women (aHR 0.14, 95% CI 0.09-0.22, <i>P</i> < .001).</p><p><strong>Conclusions: </strong>Pregnancy in women with compensated cirrhosis is not associated with increased liver-related events compared to nonpregnant women. These results can facilitate counselling women with cirrhosis of child-bearing age and suggests that pregnancy may not accelerate liver disease progression.</p>","PeriodicalId":46297,"journal":{"name":"International Journal of Hepatology","volume":" ","pages":"9985226"},"PeriodicalIF":1.5000,"publicationDate":"2022-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9279084/pdf/","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Hepatology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1155/2022/9985226","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 1
Abstract
Background and aims: Childbirth in women with cirrhosis is increasing and associated with a higher risk of perinatal outcomes compared to the general population. Whether pregnancy influences the risk of liver-related events compared to nonpregnant women with cirrhosis is unclear. This study evaluates the association between pregnancy and liver-related outcomes in women with compensated cirrhosis. Approach and Results. Population-based retrospective matched cohort study in Ontario, Canada, using routinely collected healthcare data. Pregnant women with compensated cirrhosis and without prior history of decompensation between 2000 and 2016 were identified and matched to nonpregnant women with compensated cirrhosis on age, etiology of cirrhosis, and socioeconomic status in a 1 : 2 ratio. The association between pregnancy and the composite outcome of nonmalignant decompensation, liver transplant (LT), and death up to two years after cohort entry was estimated using the multivariate Cox proportional hazard regression adjusting for potential confounders. Overall, 5,403 women with compensated cirrhosis were included (1,801 pregnant; 3,602 nonpregnant; median age 31 years (IQR 27-34); 60% nonalcoholic fatty liver disease, 34% viral hepatitis). After two years of follow-up, only 19 (1.1%) pregnant women had a liver-related event compared to 319 (8.9%) nonpregnant women. Pregnant women with compensated cirrhosis had a lower hazard of a liver-related event compared to nonpregnant women (aHR 0.14, 95% CI 0.09-0.22, P < .001).
Conclusions: Pregnancy in women with compensated cirrhosis is not associated with increased liver-related events compared to nonpregnant women. These results can facilitate counselling women with cirrhosis of child-bearing age and suggests that pregnancy may not accelerate liver disease progression.
背景和目的:与一般人群相比,肝硬化妇女的分娩正在增加,并且与围产期结局的高风险相关。与未怀孕的肝硬化妇女相比,妊娠是否会影响肝脏相关事件的风险尚不清楚。本研究评估代偿性肝硬化妇女妊娠与肝脏相关结局之间的关系。方法和结果。基于人群的回顾性匹配队列研究在加拿大安大略省,使用常规收集的医疗保健数据。在2000年至2016年期间,无代偿失代偿史的代偿性肝硬化孕妇被确定,并按1:2的比例与年龄、肝硬化病因和社会经济地位的代偿性肝硬化非孕妇进行匹配。使用多变量Cox比例风险回归对潜在混杂因素进行校正,估计妊娠与非恶性失代偿、肝移植(LT)和死亡两年内的复合结局之间的关系。总共纳入了5403名代偿性肝硬化患者(1801名孕妇;3602没有怀孕;中位年龄31岁(IQR 27-34);60%为非酒精性脂肪肝,34%为病毒性肝炎)。经过两年的随访,只有19名(1.1%)孕妇有肝脏相关事件,而319名(8.9%)非孕妇有肝脏相关事件。与非孕妇相比,代偿性肝硬化孕妇发生肝脏相关事件的风险较低(aHR 0.14, 95% CI 0.09-0.22, P < 0.001)。结论:与未怀孕的女性相比,代偿性肝硬化女性的妊娠与肝脏相关事件的增加无关。这些结果有助于为育龄期肝硬化妇女提供咨询,并表明怀孕可能不会加速肝病的进展。
期刊介绍:
International Journal of Hepatology is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies related to the medical, surgical, pathological, biochemical, and physiological aspects of hepatology, as well as the management of disorders affecting the liver, gallbladder, biliary tree, and pancreas.