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Background & Aims
The incidence of cirrhosis is increasing among women of childbearing age. Contemporary outcomes of pregnant women with cirrhosis and their infants, as well as liver-related complications, have not been described in North America, to our knowledge. 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 health care 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 postpartum and liver-related complications up to 1 year postpartum were evaluated by 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% confidence interval [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), preterm birth (RR, 1.60; 95% CI, 1.35–1.89), infants who 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 postpartum to optimize outcomes.作者: StephenW 时间: 2020-12-8 17:59