Non-selective beta blockers are well tolerated in pregnancy with portal hypertension

The study aimed at assessing the course of portal hypertension and safety of non-selective beta blockers (NSBB) in pregnant patients with portal hypertension.

Pregnant women with portal hypertension (PHT), diagnosed preconceptionally or during pregnancy, were included in this retrospective study. Medical records were assessed for NSBB prescription, liver decompensation (ascites, variceal bleed, hepatic encephalopathy), overall and pregnancy-related outcomes. All outcomes were documented at discharge from the hospital.

One-hundred thirty-four pregnancies in 93 patients (median age: 26, range [17-39 years]). The study included 54 primigravidas. Among the 93 patients, the etiology of portal hypertension was vascular in 48 and cirrhosis in 45. Of the 134 pregnancies, 90 were diagnosed with portal hypertension prior to pregnancy. Of these, 46/90 (51.1%) had a history of prior GI bleed. In the remaining 44/134, PHT was diagnosed during the index pregnancy. Of the 134 pregnancies, NSBB was prescribed during 51 pregnancies (38%; primary prophylaxis: 18, secondary prophylaxis: 33). Of these, 36 (26.9%) were started on NSBB preconceptionally, while 15 (11.2%) were initiated during pregnancy-one in first, 10 in second and four in third trimester. Sixteen (12%) patients presented with acute decompensation (ascites:13; GI bleed: 5; both 2). Of the remaining 118 pregnancies, not presenting initially with decompensation, 12 pregnancies were associated with hepatic decompensation either during antenatal or immediate post-partum period. Decompensation during pregnancy was similar in patients on NSBB (6/51, 11.8%, ascites: 3, GI bleed: 3) and not on NSBB (6/67, 8.9%; ascites: 6, GI bleed:0). Although maternal (100% survival) outcome was good, adverse fetal outcomes were noted (live: 116; abortion: 10, stillbirth: 7, neonatal death: 1). Hepatic decompensation was associated with poor fetal outcomes (live births: 69% vs. 91%, p = .03). NSBB was well tolerated with no effect on fetal outcome (p = .82), birth weight (2.5, 1.2-3.4 kg vs. 2.7, 1.1-3.7 kg; p = .12) or intra-uterine growth retardation (34% vs. 28%; p = .40).

Pregnancy is well tolerated in patients with portal hypertension, with favorable maternal outcomes. De novo decompensation was associated with adverse fetal outcomes. NSBB use appears safe and well tolerated in this subset of expectant mothers with portal hypertension.