Outcomes of Pregnant Women With Cirrhosis and Their Infants in a Population-Based Study
| Autor: | Monica Mullin, Jennifer A. Flemming, Susan B. Brogly, Monika Sarkar, Maya Djerboua, Norah A. Terrault, Jacquie Boyang Lu, Maria P. Velez |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Adult Liver Cirrhosis medicine.medical_specialty Time Factors Databases Factual Population Cholestasis Intrahepatic Rate ratio Risk Assessment 03 medical and health sciences 0302 clinical medicine Pregnancy Risk Factors Medicine Humans Labor Induced Risk factor education Retrospective Studies Ontario education.field_of_study Respiratory Distress Syndrome Newborn Hepatology business.industry Obstetrics Incidence Gastroenterology Pregnancy Outcome Gestational age Retrospective cohort study Hepatitis C medicine.disease Prognosis Pregnancy Complications 030104 developmental biology Relative risk Premature Birth 030211 gastroenterology & hepatology Female business Live Birth |
| Zdroj: | Gastroenterology. 159(5) |
| ISSN: | 1528-0012 |
| Popis: | Background & Aims The incidence of cirrhosis is increasing among women of childbearing age. Contemporary outcomes of pregnant women with cirrhosis and their infants, as well as liver-related complications, have not been described in North America, to our knowledge. We investigated the association between cirrhosis and perinatal outcomes and evaluated perinatal liver-related events. Methods We performed a retrospective cohort study using population-based administrative health care data from Ontario, Canada (2000–2017). We identified pregnant women with compensated cirrhosis (n = 2022) using validated case definitions and routine mother-infant linkage; the women were matched to 10,110 pregnant women in the general population (1:5) based on birth year and socioeconomic status. Maternal and infant outcomes up to 6 weeks postpartum and liver-related complications up to 1 year postpartum were evaluated by using multivariate log-binomial regression. Results After we adjusted for demographic and metabolic risk factors, cirrhosis was independently associated with intrahepatic cholestasis of pregnancy (relative risk [RR], 10.64; 95% confidence interval [CI], 7.49–15.12), induction of labor (RR, 1.15; 95% CI, 1.03–1.28), puerperal infections (RR, 1.32; 95% CI, 1.02–1.70), preterm birth (RR, 1.60; 95% CI, 1.35–1.89), infants who were large for gestational age (RR, 1.24; 95% CI, 1.05–1.46), and neonatal respiratory distress (RR, 1.20; 95% CI, 1.02–1.42). Fewer than 2% of pregnant women with cirrhosis had liver-related complications, but these occurred in a significantly higher proportion of women with a history of hepatic decompensation (13%) than women with compensated cirrhosis (1.2%) (P Conclusions In a population-based study, we found that cirrhosis is an independent risk factor for adverse perinatal outcomes. However, liver-related complications are rare. Multidisciplinary teams are needed to coordinate care for pregnant women with cirrhosis during pregnancy and postpartum to optimize outcomes. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|