Pregnancy Outcomes in Women With Liver Cirrhosis: A National Prospective Cohort Study Using the UK Obstetric Surveillance System

OBJECTIVE: Describe maternal/fetal outcomes of pregnant women with cirrhosis. DESIGN: Prospective, national cohort study utilising the UK Obstetric Surveillance System between 1st June 2017 and 30th November 2020. SETTING: UK. POPULATION: Pregnant women with cirrhosis. METHODS: Rates of adverse perinatal outcomes were compared with published rates for uncomplicated pregnancies. The prediction of adverse pregnancy outcomes by albumin-bilirubin (ALBI) score was determined. MAIN OUTCOME MEASURES: Maternal and fetal outcomes. RESULTS: 52 eligible cases were reported (denominators represent available data for each outcome). Commonest causes included autoimmune hepatitis (12/50 (24.0%)), cholestatic disease (9/50 (18.0%)) and viral disorders (8/50 (18.0%)). Maternal decompensation occurred in seven women. Worst ALBI score predicted decompensation and maternal ICU admission (AUROC 0.80 (p = 0.03) and 0.81 (p = 0.03), respectively). Untreated varices were associated with increased rates of variceal bleed (p = 0.01). No women died. There were 42 live births (51.2% preterm), one stillbirth, and two neonatal deaths. The worst ALBI score in pregnancy predicted pre-term birth (AUROC 0.74 (p = 0.03)). Compared to a healthy population, women with cirrhosis were at increased risk of cholestasis in pregnancy (OR 29.4, 95% CI 13.8-61.6, p < 0.001), ICU admission (OR 42.5,95% CI 15.2-118.8, p < 0.001), pre-term birth (OR 13.2, 95% CI 7.1-24.4, p < 0.001), and babies with low birth weight (OR 12.0, 95% CI 6.5-22.0, p < 0.001), neonatal intensive care unit admission (OR 4.4, 95% CI 2.4-8.2, p < 0.001) and perinatal mortality (OR 15.8, 95% CI 4.9-51.3, p < 0.001). CONCLUSION: Women with cirrhosis and their babies are at increased risk during pregnancy. The ALBI score predicts maternal decompensation, ICU admission, and pre-term birth.