Original article—liver, pancreas, and biliary tract
Impact of Cirrhosis and Liver Transplant on Maternal Health During Labor and Delivery

https://doi.org/10.1016/j.cgh.2009.08.008Get rights and content

Background & Aims

The impact of cirrhosis or prior liver transplant on maternal health during pregnancy has not been studied. We sought to characterize outcomes during labor and delivery among pregnant women with these 2 conditions.

Methods

A population-based cohort study of women admitted for labor and delivery to US hospitals between 1998 and 2005 was conducted using the Nationwide Inpatient Sample database. We compared health outcomes between pregnant women with cirrhosis or liver transplant with those without known liver disease, adjusting for potential confounders.

Results

The rates of cesarean section were higher among pregnant women with cirrhosis (n = 187; adjusted odds ratio [aOR], 2.4; 95% confidence interval [CI], 1.7–3.4) and those with prior liver transplant (n = 86; aOR, 1.8; 95% CI, 1.0–3.2), compared with general obstetrical patients (n = 662,408), as were the rates of preterm labor, peripartum infection, and hypertension. The rates of death (aOR, 42.5; 95% CI, 8.5–214), venous thromboembolism (aOR, 12.3; 95% CI, 4.9–31.0), and protein-calorie malnutrition (aOR, 67.4; 95% CI, 7.5–603), as well as the rates of placental abruption and peripartum blood transfusion, were specifically higher in cirrhotic women. Women with clinically apparent decompensated cirrhosis had higher rates of cesarean delivery, preterm labor, placenta previa, and peripartum blood transfusion than women with compensated cirrhosis.

Conclusions

Pregnant women with cirrhosis or prior liver transplant are at higher risk of developing numerous adverse health problems than pregnant women without these conditions. Further prospective studies are warranted to assess the benefit of aggressive preventative measures and involvement of multidisciplinary health care teams.

Section snippets

Data Source

All data were extracted from the Nationwide Inpatient Sample (NIS) between the years 1998 and 2005. The NIS database contains discharge abstracts from more than 1000 academic and community hospitals in the United States, reflecting a 20% stratified sample of all nonfederal acute care hospitals. The database is maintained as part of the Healthcare Cost and Utilization Project, sponsored by the Agency for Healthcare Research and Quality. NIS data concur with the National Hospital Discharge

Results

In the NIS database, there were 187 infant deliveries among cirrhotic women and 86 infant deliveries among women with transplanted livers, corresponding to 930 and 419 total deliveries, respectively, in these groups of patients throughout the United States between 1998 and 2005. There also were 662,408 infant deliveries among the 10% sample of women without liver disease. There were no significant time trends in the number of admissions for either cirrhosis or prior liver transplant over the

Discussion

In this nationwide analysis of obstetrical patients, we have been able to show that women with a history of cirrhosis or liver transplant at the time of pregnancy have an increased rate of serious health complications and longer LOHS during labor and delivery than women without any known liver disease. Cirrhotic women had a greater overall risk of adverse health outcomes than women who had undergone prior liver transplant; moreover, several of the complications observed in women with prior

References (29)

  • A. Pajor et al.

    Pregnancy in liver cirrhosisAssessment of maternal and fetal risks in eleven patients and review of the management

    Gynecol Obstet Invest

    (1994)
  • V. Christopher et al.

    Pregnancy outcome after liver transplantation: a single-center experience of 71 pregnancies in 45 recipients

    Liver Transpl

    (2006)
  • D. Whalen et al.

    2002 HCUP Nationwide Inpatient Sample (NIS) comparison report

    U S Agency for Healthcare Research and Quality

    (2005)
  • H. Quan et al.

    Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data

    Med Care

    (2005)
  • Cited by (0)

    Conflicts of interest The authors disclose no conflicts.

    Funding This work was supported by an AGA Research Scholar Award by the Foundation for Digestive Health and Nutrition (G.C.N.). The sponsor had no role in the study design, collection, analysis, or interpretation of data.

    View full text