Liver cirrhosis and pregnancy

The liver accomplishes multiple functions such as the biotransformation of insoluble compounds (drugs, toxins, bilirubin), the metabolism and excretion of lipids (cholesterol in particular) the production of several plasma proteins (good examples are albumin, coagulation factors, transferrin), and the metabolism of amino acids and carbohydrates. The liver also plays a crucial role in the metabolism of different hormones, estrogens and progesterone among the others. This explains why during a chronic liver disease (CLD) severe alteration on the hormonal status occurs. Cirrhosis is often associated with amenorrhea and consequently, women with CLD (cirrhosis obviously included) have difficulty conceiving. If pregnancy occurs, it is associated with an increased risk of complications. Approximately 15 to 20 percent of pregnant women with CLD suffer spontaneous abortion, increased risk for premature childbirth or stillbirth. 1 If portal hypertension is present bleeding from esophageal varices is the biggest risk for women with cirrhosis. Variceal bleeding is most common during the second trimester, occurring in approximately 20 to 45 percent of women with portal hypertension. Variceal bleeding may also occur during labor. Death of the mother is similar to that occurring in the absence of pregnancy and accounts for about 20%. 2 It is recommendable that women with cir