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Pregnancy in women with liver cirrhosis is associated with increased risk for complications: a systematic review and meta-analysis of the literature
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  • Laurine van der Slink,
  • Irma Scholten,
  • Faridi van Etten-Jamaludin,
  • Bart Takkenberg,
  • Rebecca Painter
Laurine van der Slink
Amsterdam UMC Locatie Meibergdreef
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Irma Scholten
Deventer Hospital
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Faridi van Etten-Jamaludin
Amsterdam UMC Locatie Meibergdreef
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Bart Takkenberg
Amsterdam UMC Locatie Meibergdreef
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Rebecca Painter
Amsterdam UMC Locatie Meibergdreef
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Abstract

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 hemorrhage decreased comparing recent and older studies. Most cases of maternal mortality due to variceal hemorrhage (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), cesarean section (OR 2.6, 95% CI 1.7-3.9), preeclampsia (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 to the general obstetric population. Subgroup-analyses could not be conducted. Conclusions Liver cirrhosis in pregnant women is associated with serious increases in maternal mortality and obstetric and fetal complications. Large international prospective studies are needed to identify risk factors for unfavorable outcome.

Peer review status:ACCEPTED

28 Feb 2021Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
01 Mar 2021Submission Checks Completed
01 Mar 2021Assigned to Editor
19 Mar 2021Reviewer(s) Assigned
30 Apr 2021Review(s) Completed, Editorial Evaluation Pending
10 May 2021Editorial Decision: Revise Major
04 Jun 20211st Revision Received
07 Jun 2021Submission Checks Completed
07 Jun 2021Assigned to Editor
07 Jun 2021Review(s) Completed, Editorial Evaluation Pending
18 Jun 2021Editorial Decision: Accept