The objective of a study was to find prognostic markers of liver cirrhosis hepatic decompensation, which may enable the prediction of pregnancy outcomes in these patients.

This study entailed reviewing of medical records of women with chronic liver disease (CLD) who became pregnant between 1983 and 2017, from the King’s College Hospital. 

Out of the 165 pregnancies among patients attending the hepatology clinic, 80 occurred in women with CLD and 48 in those with liver cirrhosis. The median age for conception in cirrhotic and non-cirrhotic women were 26 years and 28 years, respectively.

It was noted that the birth rate in women with cirrhosis was comparable to those of non-cirrhotic women. However, pregnancies in women with liver cirrhosis were less likely to proceed beyond 37 weeks gestation. Additionally, women who underwent preconception counseling were more likely to maintain stable liver disease at conception. Meanwhile, the preconception Albumin-Bilirubin score (ALBI) more accurately predicted live birth than preconception model for end stage liver disease (MELD). In addition, preconception AST to platelet ratio index (APRI) more accurately predicted ability to proceed beyond 37 weeks gestation. 

The results showed that women with cirrhosis, who conceived, usually had successful pregnancy outcomes. ALBI and APRI scores can be useful tools in determining the prognosis of pregnancy outcomes in women with CLD. Furthermore, preconception counseling by a hepatologist or obstetrician can aid in improving patient care.

Source: The American Journal of Gastroenterology. 2019; 114: 2 (267-275). doi: 10.1038/s41395-018-0181-x