Outcomes of Pregnancy in Patients With Chronic Liver Disease

Background and objectives  Chronic liver disease (CLD), due to its increased prevalence, is a global public health concern. With improved care of CLD patients nowadays, more patients with liver cirrhosis or CLD are getting pregnant. Pregnancy in the setting of CLD is associated with significant maternal and fetal complications. The objectives of this study were to determine the outcomes of pregnancy in patients with CLD and to ascertain the association between maternal CLD and pregnancy outcomes. Materials and methods This retrospective study was conducted at the Gastroenterology Department of Hayatabad Medical Complex, Peshawar, after approval from the hospital's ethical committee. A total of 91 pregnant patients with CLD were included. Data of these patients were retrieved from the hospital information management system. Baseline parameters and clinical parameters of the study participants were recorded. Maternal outcomes and fetal outcomes were noted. Data was analyzed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). Inferential statistics, including univariate logistic regression analysis, was used to determine various factors influencing the fetomaternal outcomes. p-value ≤0.05 was considered statistically significant. Results The mean age of patients was 30.85±6.20 years, the mean gestational age was 29.66±4.15 weeks, and the mean CLD duration was 27.65±9.481 months. Viral hepatitis was the most frequent etiology of CLD (62.6%). Fifty-four patients (59.3%) were noted to have used fertility medications. Regarding maternal outcomes, 13 (14.3%) patients had preterm labor, 47 patients (51.6%) had a cesarean section as a mode of delivery, and post-partum hemorrhage (PPH) was observed in 13 (14.3%) patients. In terms of fetal outcomes, low birth weight was observed in 29 (31.9%) babies, intrauterine death (IUD) was noted in 13 (14.3%) babies and 27 babies (29.7%) had low Apgar scores at birth. The CLD duration was significantly associated with the mode of delivery (p<0.001). Similarly, maternal age (p=0.049), body mass index (p=0.017), and decompensated CLD (p=0.030) were associated with a high likelihood of IUD. Maternal age was associated with the likelihood of a low Apgar score (p=0.013). Conclusion Pregnancy in patients with CLD is associated with an increased risk of maternal complications (preterm labor and PPH) and fetal complications (IUD, low birth weight, and low Apgar score). Maternal age, body mass index, and decompensated CLD are associated with an increased likelihood of IUD.