Long-term risk of chronic liver disease after pre-eclampsia

Pre-eclampsia is associated with acute hepatic complications, but the risk of developing chronic liver disease is unclear. We determined whether pre-eclampsia was associated with chronic liver disease for up to three decades after pregnancy.

We conducted a longitudinal population-based cohort study of 1 460 099 pregnant women with and without pre-eclampsia in Quebec, Canada, between 1989 and 2022. The main exposure was pre-eclampsia in any pregnancy. Outcomes included hospitalization for liver disease during 26 275 081 person-years of follow-up after pregnancy. Using Cox regression models adjusted for age, comorbidity, and socio-economic disadvantage, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between pre-eclampsia and liver disease.

Women with pre-eclampsia had a higher incidence of hospitalization for liver disease than women without pre-eclampsia (119.3 vs. 61.5 per 100 000 person-years). During a median follow-up of 18.4 years, pre-eclampsia was associated with 1.85 times the risk of hospitalization for liver disease (95% CI 1.75-1.95). Early-onset pre-eclampsia (HR 2.36, 95% CI 2.04-2.74), superimposed pre-eclampsia (HR 2.78, 95% CI 2.30-3.36), and pre-eclampsia recurring in more than one pregnancy (HR 3.00, 95% CI 2.59-3.46) were strongly associated with liver hospitalization. Associations were present with several liver complications, including hepatic cirrhosis, chronic hepatitis, fatty liver disease, and hepatic failure. Pre-eclampsia was more strongly associated with hepatic hospitalization within 5 years of pregnancy, although risks persisted for up to 33 years later.

Pre-eclampsia is associated with the long-term risk of liver disease up to 33 years after pregnancy.