乌鸦传媒

BOSTON -- Adverse liver-related outcomes for pregnant women with cirrhosis may be much less common than previous data would suggest, a researcher said here.

Less than 1% of women with compensated cirrhosis experienced a liver decompensation event up to 1 year postpartum, and adverse liver outcomes, such as hepatic decompensation, death, or need for liver transplant was lower in this population compared with women with cirrhosis who were not pregnant, reported Jennifer Flemming, MD, of Queen's University in Ontario, Canada.

Understanding these complications has become more important over the past decade, as the incidence of cirrhosis is rising fastest in women of child-bearing age, and the number of women with cirrhosis who are becoming pregnant is increasing, Flemming said at a press conference at the Liver Meeting, the annual meeting of the American Association for the Study of Liver Diseases (AASLD).

But a lot of the information about liver-related outcomes in pregnancy is outdated. Flemming explained how the data is from cohort studies conducted prior to the year 2000, prior to both the epidemic of non-alcoholic fatty liver disease (NAFLD), as well as the ability to treat viral hepatitis.

"Historically, women could have variceal hemorrhage, and up to 25% had ascites [excess abdominal fluid that causes swelling]. More concerningly, the risk of death was up to 10%," she said. "As clinicians ... we get nervous when we see pregnant women with cirrhosis."

But in a small study from Sweden that examined about 100 pregnancies, there was only one case of variceal hemorrhage and no deaths. Flemming and her colleagues wanted to examine this issue further, using more patients, she stated.

AASLD press conference moderator Meena Bansal, MD, of Mount Sinai Health System in New York City, commented on the importance of the findings for clinicians, who have previously "scared the life" out of pregnant women with cirrhosis, given the existing data on outcomes. But this study adds new data to the conversation.

"When we give advice to patients, it has to be based on actual data," she said.

This retrospective cohort study examined data from 1,801 pregnant women in Ontario with a history of compensated cirrhosis and no liver-related event. These women were matched 1:2 with 3,602 non-pregnant women with cirrhosis based on age, cirrhosis etiology, and socioeconomic status. Women were a mean age of about 31, and cirrhosis etiology was NAFLD/cryptogenic for about 60% of women.

Among these, nine pregnant women had hepatic decompensation. Researchers noted that data that contains smaller cells <5 were not reportable due to the risk of re-identification, so pregnant women with a liver transplant or a death were only identified as "less than 5." The risk of these adverse outcomes was significantly lower compared with non-pregnant controls.

"It's probably mostly related to women with cirrhosis who can get pregnant have better liver function and ... are engaging in healthcare," Flemming said. "This helps to reassure healthcare providers and patients that chances are, there won't be any adverse liver-related outcomes."

They also found that only 33 pregnant women experienced liver decompensation events within a year after giving birth, with 12 each with liver failure/hepatorenal syndrome (a type of progressive kidney failure) and ascites, and nine with variceal hemorrhage.

However, Flemming said the researchers have yet to examine infant outcomes from the women examined in this study.

"We will be looking at maternal and fetal outcomes ... that will be presented in a future work," she told 乌鸦传媒.

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