Outcomes of Pregnant Women With Cirrhosis and Their Infants in a Population-Based Study

Flemming, Jennifer A.; Mullin, Monica; Lu, Jacquie; Sarkar, Monika; Djerboua, Maya; Vélez, Maria P.; Brogly, Susan B.; Terrault, Norah A.

doi:10.1053/j.gastro.2020.07.052

Cited by 46 publications

(102 citation statements)

References 31 publications

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“…( 64 ) Fertility rates are similar in patients with compensated cirrhosis and the general population but are 40% lower in women with a history of decompensation. ( 65 ) Hypothalamic–pituitary dysfunction is associated with an inadequate response to gonadotropic‐releasing hormone agonists and clomiphene citrate as well as diminished gonadotrophin release relative to the reduced levels of circulating sex steroids. ( 7 ) In the post‐LT literature, several case reports describe pregnancies with successful births after assisted reproduction.…”

Section: Sexual Function Across Age In Patients With Chronic Liver DImentioning

confidence: 99%

Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases

et al. 2021

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Section: Sexual Function Across Age In Patients With Chronic Liver DImentioning

confidence: 99%

Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases

et al. 2021

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“…Death rates in pregnant women with cirrhosis range from 0% to 14%; older studies report higher rates, while newer ones report rates <2% 5,8,9,12,14,25,31–33 …”

Section: Maternal Complicationsmentioning

confidence: 99%

“…Women with cirrhosis are more likely to have pre‐pregnancy co‐morbidities (e.g. diabetes, hypertension, obesity and dyslipidaemia) when compared to the gen‐eral population 8 …”

Section: Maternal Complicationsmentioning

confidence: 99%

“…Flemming et al. have recently demonstrated that pregnancies in women with cirrhosis are independently associated with induction of labour, puerperal infec‐tions, preterm delivery, large for gestational age infants and neonatal respiratory distress 8 …”

Section: Maternal Complicationsmentioning

confidence: 99%

“…Post‐partum haemorrhage (PPH) occurs in 5%–45% of women with cirrhosis 8,10,11,14,25,31 . This is due to a combination of factors: thrombocytopaenia, imbalance of coagulation factors and aberrant variceal formation.…”

Section: Maternal Complicationsmentioning

confidence: 99%

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Management of pregnancy in women with cirrhosis

et al. 2021

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Although pregnancy is rare in women with cirrhosis, it is increasingly prevalent in an era of modern assisted conception techniques and improved awareness, monitoring and management of underlying liver disease. After overcoming the difficulties of subfertility and becoming pregnant, women undergo a ‘high-risk’ pregnancy which can be complicated by variceal haemorrhage (≤50%) and hepatic decompensation (≤25%). Management of these complications are similar to non-pregnant individuals. However, there are a few caveats to consider. These pregnancies are associated with adverse maternal and foetal outcomes, such as mortality (0–8%) and prematurity (19–67%) in the newborn, and mortality (0–14%), pregnancy-induced hypertension (5–22%) and post-partum haemorrhage (5–45%) in the mother. Pre-pregnancy counselling, use of predictive scores and appropriate variceal screening during pregnancy can stratify patients and improve outcomes. This review focusses on the complications that can occur during pregnancy in women with cirrhosis.

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Autoimmune hepatitis in pregnancy: Pearls and pitfalls

Chung

Heneghan

2022

Hepatology

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Autoimmune hepatitis (AIH) in pregnancy has many unique considerations.Evidence provided from single center studies with patient level data and nationwide population studies provide valuable insight into this complex situation. Because a planned pregnancy is a safer pregnancy, preconception counseling is a crucial opportunity to optimize care and risk stratify women with AIH. Women with chronic liver disease who receive preconception advice and counseling are more likely to achieve stable liver disease at conception and undergo appropriate variceal surveillance. Loss of biochemical response in pregnancy is associated with adverse outcomes in unstable disease. New onset AIH in pregnancy should be managed with classical treatment regimens. The continued use of immunosuppression in pregnancy, with the exception of mycophenolate mofetil, has not shown to adversely affect the rates of stillbirth or congenital malformation. Previously adopted immunosuppression withdrawal paradigms in pregnancy should no longer be considered advantageous, because remission loss postdelivery is likely (12%-86%). Population studies, report improved outcomes with preterm birth rates falling from 20% to 9%-13% in AIH pregnancies over a 20-year period.Newer data have also demonstrated an increased risk of gestational diabetes and hypertensive complications in AIH pregnancy, which has implications for management and preeclampsia prevention with aspirin use. This review aims to provide the framework to guide and manage pregnancy in AIH outlining pearls and pitfalls to ensure optimal outcomes for mother, baby and to reduce variation in practice.

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Outcomes of Pregnant Women With Cirrhosis and Their Infants in a Population-Based Study

Abstract: Includes gestational hypertension; eclampsia; preeclampsia; and hypertension, elevated liver enzymes, and low platelets.

Cited by 46 publications

References 31 publications

Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases

Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases

Management of pregnancy in women with cirrhosis

Autoimmune hepatitis in pregnancy: Pearls and pitfalls

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