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Portal hypertension in pregnancy
Dorien Pint1,2, Yooyun Chung2, Michael A Heneghan2
1University Hospital Antwerp, Edegem, Belgium.
Current Opinion in Gastroenterology
|February 25, 2025
Summary
Pregnancy with portal hypertension (PHT) poses risks due to physiological changes. Preconception counseling and multidisciplinary care are vital for managing PHT in pregnancy and ensuring favorable maternal and fetal outcomes.
Area of Science:
- Hepatology
- Obstetrics
- Maternal-Fetal Medicine
Background:
- Pregnancy in women with portal hypertension (PHT) is increasingly common.
- Physiological changes during pregnancy can exacerbate PHT, increasing risks of severe complications like variceal bleeding.
- Differentiating between noncirrhotic portal hypertension (NCPH) and cirrhotic portal hypertension (CPH) is crucial as maternal risks differ significantly.
Purpose of the Study:
- To review the management strategies for pregnant women with PHT.
- To highlight maternal and fetal outcomes in PHT pregnancies.
- To emphasize the importance of prepregnancy counseling for women with PHT.
Main Methods:
- This is a review article, synthesizing existing literature on PHT in pregnancy.
- Key aspects covered include physiological changes, risk stratification, and management protocols.
- Emphasis is placed on the role of multidisciplinary teams.
Main Results:
- Pregnancy significantly increases risks for women with PHT, particularly concerning variceal bleeding.
- Maternal and fetal outcomes are influenced by the type of PHT (cirrhotic vs. noncirrhotic).
- Proactive management, including screening for complications, is essential.
Conclusions:
- Preconception counseling is critical for risk assessment, medication adjustment, and planning investigations (e.g., variceal screening).
- A multidisciplinary team approach involving hepatologists, obstetricians, and other specialists ensures personalized care.
- Despite complications, favorable outcomes in PHT pregnancies are achievable with careful planning and monitoring.
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