Cirrhosis Affects Maternal and Foetal Outcomes in Pregnancy

TOPLINE: 

The albumin-bilirubin (ALBI) score predicted adverse outcomes such as preterm birth, intensive care unit (ICU) admission, and perinatal mortality in pregnant women with cirrhosis.

METHODOLOGY:

• This prospective, national observational cohort study was conducted using the UK Obstetric Surveillance System (UKOSS) from June 1, 2017, to November 30, 2020.
• The study identified 52 pregnant women with cirrhosis (median age, 34 years) among an estimated 2,256,366 maternities, with data collected from all 193 UK consultant-led obstetric units.
• Cirrhosis was confirmed via liver biopsy, radiological findings, or clinical/laboratory evidence.
• The ALBI score’s ability to predict adverse pregnancy outcomes was assessed using the area under the receiver operating characteristic curve (AUROC).
• The outcomes included the incidence of adverse maternal and foetal outcomes such as preterm birth, low birth weight, and perinatal mortality.

TAKEAWAY:

• The study revealed a significant incidence rate of 2.3 cases of cirrhosis per 100,000 maternities.
• Preterm birth occurred in 51.2% of live births among pregnant women with cirrhosis, who had a higher risk than healthy pregnant women (odds ratio [OR], 13.2; P < .001). Caesarean section was performed in 48.8% of cases. 
• Pregnant women with cirrhosis had a higher risk for low-birth-weight infants (P < .0001), neonatal ICU admission (P < .0001), and perinatal mortality (P < .001) than healthy pregnant women.
• The ALBI score predicted maternal decompensation, ICU admission, and preterm birth (AUROC, 0.80, 0.82, and 0.74, respectively; P = .03 for all).

IN PRACTICE:

“Women with cirrhosis and their babies are at increased risk during pregnancy. The ALBI score predicts maternal decompensation, ICU admission, and preterm birth,” the authors wrote. 

SOURCE:

The study was led by Melanie Nana, Department of Women and Children’s Health, King’s College London, London, United Kingdom. It was published online on March 13, 2025, in BJOG: An International Journal of Obstetrics & Gynaecology. 

LIMITATIONS:

The study’s limitations included a small sample size, possible missed cases, and the lack of follow-up due to UKOSS anonymity. Non-UK data were used for some outcomes, making it difficult to assess disease control, which may have affected maternal and foetal outcomes. Additionally, the absence of biochemistry data prevented the calculation of prediction scores.

DISCLOSURES:

The study was supported by the Lauren Page Trust. The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.