4 Questions About Pregnancy and Liver-Related Events in Cirrhosis

Few studies have evaluated the impact of pregnancy on liver decompensation events in women with cirrhosis.

In a new study, Jennifer Flemming, MD, MAS, an assistant professor in the Division of Gastroenterology and Department of Public Health Sciences at KHSC Kingston Health Sciences Centre in Kingston, Ontario, and colleagues sought to describe the association between pregnancy and liver-related events among 5607 women with cirrhosis. Of these women, 1869 were pregnant and 3738 were not pregnant.

Findings of the study showed that less than 2% of pregnant women had liver decompensation within 1 year of delivery, with a significantly lower odds of decompensation compared with women who were not pregnant.

Gastroenterology Consultant caught up with Dr Flemming about the research, which was presented at The Liver Meeting 2019.

Gastroenterology Consultant: What prompted you to conduct the study?

Jennifer Flemming: The burden of chronic liver disease and cirrhosis is increasing in North America. Data from both the United States and Canada have highlighted that the increasing burden of chronic liver disease and cirrhosis is disproportionally higher among adults younger than 40 years. In a separate study, we showed that in Canada, the increase in cirrhosis incidence was most rapid among women of childbearing age.2 Issues related to fertility and pregnancy in young women with cirrhosis are increasingly becoming a clinical concern.

GASTRO CON: What do you think is the most important finding?

JF: In our study that included a population-based cohort of more than 1800 women with compensated cirrhosis who were pregnant, the proportion of women who had a liver–related outcome up to 1 year postpartum was much lower than had previously been reported. Historically, literature which included small groups of pregnant women with cirrhosis prior to the year 2000 suggested that a poor outcome occurred in up to 50% of women, with some studies suggesting death could occur in up to 10%.3 In our data, the risk of a liver decompensation event was less than 1% and was much lower when compared with women with cirrhosis who were of similar age and socioeconomic status. Further, less than 5 women (<0.2%) died during the follow-up period.

GASTRO CON: From the study findings, what is most important for specialists to know?

JF: The data are important to both patients and clinicians who manage this patient population. Given previous study results, pregnancy in women with cirrhosis was typically met with high levels of anxiety. We hope the findings of this study will help to reassure both women and their providers that most pregnancies in women with cirrhosis are successful. 

GASTRO CON: What are the next steps of your research?

JF: We are evaluating both maternal and infant outcomes in this cohort to provide a more comprehensive description of all outcomes during pregnancy, and these results will be presented at the upcoming International Liver Congress in London in April 2020. We hope to help providers counsel patients and to help inform clinical practice guidelines in women with cirrhosis.

References:

1. Flemming JA, Mullin M, Lu J, et al. Liver-related outcomes in pregnant women with cirrhosis: a population-based study [abstract 57]. Hepatology. 2019;70(suppl 1):40A-41A.
2. Flemming JA, Dewit Y, Mah JM, Saperia J, Groome PA, Booth CM. Incidence of cirrhosis in young birth cohorts in Canada from 1997 to 2016: a retrospective population-based study. Lancet Gastroenterol Hepatol. 2019;4(3):217-226. https://doi.org/10.1016/S2468-1253(18)30339-X.
3. Westbrook RH, Dusheiko G, Williamson C. Pregnancy and liver disease. J Hepatol. 2016;64(4):933-945. https://doi.org/10.1016/j.jhep.2015.11.030.