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.

(BJOG. 2022;129:1644–1652) Pregnancy in women with liver cirrhosis is rare (1 in 4500 pregnancies) and when it does occur, cirrhosis most commonly originates from autoimmune and viral hepatitis, and alcoholic and nonalcoholic fatty liver disease. The concurrence of pregnancy with liver cirrhosis is increasing and this combination warrants careful attention to family planning and obstetric management. Previous small studies have shown cirrhotic pregnancies have high risk of maternal and perinatal morbidity and mortality. This systematic review and meta-analysis combined a larger patient population over time to detail the obstetric, fetal, and maternal complications experienced by women with liver cirrhosis.

Linked article: This is a mini commentary on Laura J. O’Byrne et al., pp. 1236–1246 in this issue. To view this article visit https://doi.org/10.1111/1471-0528.17093.