There is emerging evidences suggesting the increased rates of pregnancy in women with cirrhosis. Thus, specific obstetric and hepatology care is warranted to reduce the risk of hepatic decompensation during pregnancy. Nevertheless, prognostic markers evaluating pregnancy outcomes are still insufficient.

The study included medical records of women who attended hepatology clinic at Kings College Hospital with chronic liver disease (CLD) who became pregnant from 1983 to 2017. The authors gathered information on demographics, clinical history, serology, and outcome of pregnancy.

The outcome revealed that 165 pregnancies occurred in 100 women with CLD comprising 80 pregnancies in 48 women with cirrhosis. Median age of conception in cirrhotic and non-cirrhotic women were 26 years (16-44) and 28 years (16-51) respectively. Similar live births were recorded in women with cirrhosis and non-cirrhotic women (75 vs. 85%), whereas women with cirrhosis were less probable to proceed beyond 37 weeks gestation (45 vs. 58%). However, the outcome of preconception counseling was positive as women who received it were more likely to have stable liver disease at conception (100 vs 86%). Preconception Albumin-Bilirubin score (ALBI) more correctly projected live birth with an area under the receiver-operator curve (AUROC) of 0.741, while preconception AST to platelet ratio index (APRI) more exactly reported ability to proceed beyond 37 weeks gestation with an AUROC of 0.700 in contrast to preconception MELD (model for end stage liver disease).

Thus, it can be concluded that majority of women with cirrhosis who conceived can have a successful pregnancy outcome. ALBI and APRI scores are accurate prognostic markers to predict pregnancy outcomes in women with CLD. Additionally, preconception counseling conducted by a hepatologist or specialist obstetrician has the potential to enhance patient care in pregnant women with cirrhosis.

Source: Non-Invasive Markers (ALBI and APRI) Predict Pregnancy Outcomes in Women With Chronic Liver Disease. Am J Gastroenterol. 2019 Feb;114(2):267-275.