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Low risk for adverse cirrhosis events in pregnant women ‘reassuring’

BOSTON — In pregnant women with cirrhosis, less than 2% had liver decompensation within 1 year after delivery and the odds for decompensation were lower compared with women who were not pregnant with cirrhosis, according to data presented at The Liver Meeting 2019.

“In North America over the past 5 years, it’s become apparent that there is an increasing burden of chronic liver disease and cirrhosis in young people and data that we looked at have shown this is increasing fastest in women of child-bearing age,” Jennifer A. Flemming, MD, FRCP(C), MAS, from Queen’s University in Ontario, Canada, said during a press conference. “Over the past decade, issues related to fertility and pregnancy in this population have become more clinically important.”

Flemming explained that while there is data available on this population, most of the information on liver-related outcomes is from cohorts before the year 2000 prior to the current nonalcoholic fatty liver disease epidemic and the ability to treat viral hepatitis.

“Looking at this data, it makes us nervous, but there was one study from Sweden last year ... that showed the liver events were not as frequent as they were previously estimated to be,” she said.

To evaluate the association between pregnancy and liver-related events in women with cirrhosis, Flemming and colleagues analyzed 1,869 pregnant women and 3,738 women who were not pregnant, matched by age, cirrhosis etiology and socioeconomic status. The median age was 31 years.

Follow-up was from time of conception to 1-year post-partum. The primary outcome was hepatic decompensation.

Pregnant women were less likely to experience decompensation events compared with women who were not pregnant (1.8% vs. 9.3%). After adjusting for morbid illness using the Charlson comorbidity index, pregnancy correlated with a lower risk for hepatic decompensation (OR = 0.17; 95% CI, 0.12-0.24).

Flemming noted that the results were “reassuring” for both health care providers and patients as the chances for adverse liver-related outcomes are low for young pregnant women with cirrhosis.

“The other thing that was intriguing is whether or not pregnancy has any protective effect on the liver,” she concluded. “It is probably most likely related to the fact that women with cirrhosis who are able to get pregnant had better liver function and are engaging in health care, but there is some historic data that suggests there may be a protective element.” – Talitha Bennett

Reference: Flemming JA. Abstract 0057. Presented at: The Liver Meeting; Nov. 7-12, 2019; Boston.

Disclosure: Flemming reports grant or research support from Gilead Sciences Canada and speaking or teaching roles with Gilead Sciences Canada, Lupin and Merck.