Pregnancy in women with liver cirrhosis is associated with increased
risk for complications: a systematic review and meta-analysis of the
literature
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.