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Pregnancy not contraindicated in non-cirrhotic portal hypertension

Despite a significant incidence of portal hypertension-related complications, overall pregnancy outcomes remained favorable in women with idiopathic non-cirrhotic portal hypertension, according to a study published in Journal of Hepatology.

“About 15% of patients with [idiopathic non-cirrhotic portal hypertension (INCPH)] are women of childbearing age, who can become pregnant. However, pregnancy and postpartum are prothrombotic states and pregnancy might exacerbate portal hypertension,” Pierre-Emmanuel Rautou, MD, PhD, from Hôpital Beaujon in France, and colleagues wrote. “Our main findings are that maternal outcome is good ... and that fetal outcome is relatively favorable when pregnancy reaches 20 weeks of gestation.”

The multicenter study included 16 women who had a total of 24 pregnancies after being diagnosed with INCPH. None of the four women with portal branch thrombosis prior to conception had progression during pregnancy.

Median duration of gestation was 35 weeks (range, 22-38 weeks), during which the researchers observed one ectopic pregnancy, four miscarriages and one pregnancy terminated at 20 weeks of gestation due to prenatal diagnosis of Down syndrome.

Of the 18 pregnancies that reached 20 weeks of gestation, one child was born preterm at 27 weeks following premature rupture of membranes and chorioamnionitis, eight births were moderately preterm and nine births reached term.

Six complications related to portal hypertension occurred in the total of 24 pregnancies, including two variceal bleedings, three cases of worsening ascites, and one case of worsening portopulmonary hypertension.

At study end, no patients developed encephalopathy or liver failure. Additionally, no women died during the study and all were asymptomatic after a median follow-up of 27 months after last delivery.

“Pregnancy should not be contraindicated in women with INCPH with a well-controlled liver disease,” Andrade and colleagues wrote. “These women should however be informed of the risk of liver related events and of the high rate of miscarriage and preterm birth and be managed by a multidisciplinary team of hepatologists and obstetricians well versed in high-risk pregnancies.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.