Journal
BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY
Volume 129, Issue 10, Pages 1644-1652Publisher
WILEY
DOI: 10.1111/1471-0528.17156
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Pregnancy and liver cirrhosis is a rare combination, but it is becoming more common. Liver cirrhosis increases the chances of maternal and fetal mortality and morbidity, although the exact risks are still unknown. A systematic literature review and meta-analysis were conducted to investigate maternal, fetal, and obstetric complications in pregnant women with liver cirrhosis. The results showed that pregnant women with liver cirrhosis have a higher risk of maternal mortality, variceal hemorrhage, preterm delivery, cesarean section, pre-eclampsia, and small-for-gestational-age neonates compared to the general obstetric population. Further large international prospective studies are needed to identify risk factors for unfavorable outcomes.
Background: Pregnancy and liver cirrhosis is a rare but increasing combination. Liver cirrhosis can raise the chance of maternal and fetal mortality and morbidity, although the exact risks remain unclear. Objective: To provide a systematic literature review and meta-analysis on maternal, fetal and obstetric complications among pregnant women with liver cirrhosis. Search strategy: We performed a systematic literature search in the databases PubMed/MEDLINE and EMBASE (Ovid) from inception through 25 January 2021. Selection criteria: Studies including pregnancies with liver cirrhosis and controls were eligible. Data collection and analysis: Two reviewers independently evaluated study eligibility. We used the random effects model for meta-analysis. Main results: Our search yielded 3118 unique papers. We included 11 studies, including 2912 pregnancies in women with cirrhosis from 1982--2020. Seven studies were eligible for inclusion in the meta-analysis. The overall maternal mortality rate was 0.89%. Maternal mortality and variceal haemorrhage were lower in recent than in older studies. Most cases of maternal mortality due to variceal haemorrhage (70%) occurred during vaginal delivery. Pregnant women with liver cirrhosis had a higher chance of preterm delivery (OR 6.7, 95% CI 5.1--9.1), caesarean section (OR 2.6, 95% CI 1.7-3.9), pre--eclampsia (OR 3.8, 95% CI 2.2- -6.5) and small-for-gestational-age neonates (OR 2.6, 95% CI 1.6- -4.2) compared with the general obstetric population. Subgroup analyses could not be conducted. Conclusions: Liver cirrhosis in pregnant women is associated with increases in maternal mortality and obstetric and fetal complications. Large international prospective studies are needed to identify risk factors for unfavourable outcome.
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