Outcomes of Pregnancy in Mothers With Cirrhosis: A National Population‐Based Cohort Study of 1.3 Million Pregnancies
There are limited data on pregnancy outcomes in women with cirrhosis. To address this gap, we examined the records of singleton births from Sweden’s National Patient Register (NPR), Cause of Death Register (CDR), and Medical Birth Register (MBR) between 1997 and 2011 to assess exposure and pregnancy...
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2018-11-01
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doaj-7a3ba4b95e6c44e7816e427a528a60e22020-11-25T01:02:08ZengWileyHepatology Communications2471-254X2018-11-012111299130510.1002/hep4.1255Outcomes of Pregnancy in Mothers With Cirrhosis: A National Population‐Based Cohort Study of 1.3 Million PregnanciesHannes Hagström0Jonas Höijer1Hanns‐Ulrich Marschall2Catherine Williamson3Michael A. Heneghan4Rachel H. Westbrook5Jonas F. Ludvigsson6Olof Stephansson7Center for Digestive Diseases, Division of Hepatology Karolinska University Hospital Stockholm SwedenUnit of Biostatistics, Institute of Environmental Medicine Karolinska Institute Stockholm SwedenDepartment of Molecular and Clinical Medicine and Wallenberg Laboratory, Institute of Medicine Sahlgrenska Academy, University of Gothenburg Gothenburg SwedenDepartment of Women and Children’s HealthInstitute of Liver Studies King’s College Hospital London United KingdomSheila Sherlock Liver Unit Royal Free Hospital London United KingdomDepartment of Medical Epidemiology and Biostatistics Karolinska Institute Stockholm SwedenClinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute Stockholm SwedenThere are limited data on pregnancy outcomes in women with cirrhosis. To address this gap, we examined the records of singleton births from Sweden’s National Patient Register (NPR), Cause of Death Register (CDR), and Medical Birth Register (MBR) between 1997 and 2011 to assess exposure and pregnancy‐related and liver‐related outcomes of pregnant women with cirrhosis. Exposure status was defined as having an International Classification of Diseases (ICD) code for cirrhosis obtained prior to or during pregnancy. Poisson regression with cluster‐robust standard errors was used to estimate relative risks (RRs) adjusted for maternal age, smoking, and body mass index (BMI). We identified 103 pregnancies in women with cirrhosis and compared these to 1,361,566 pregnancies in women without cirrhosis. Pregnancies in women with cirrhosis were at increased risk of caesarean delivery (36% versus 16%, respectively; adjusted RR [aRR], 2.00; 95% confidence interval [CI], 1.47‐2.73), low birth weight (15% versus 3%; aRR, 3.87; 95% CI, 2.11‐7.06), and preterm delivery (19% versus 5%; aRR, 3.51; 95% CI, 2.16‐5.72). Rates of maternal mortality during pregnancy (no cases), gestational diabetes, preeclampsia, small for gestational age, congenital malformations, and stillbirth were not increased when compared to the pregnant women without cirrhosis. There were 12 hospitalizations during pregnancy due to liver‐related events, including one case with bleeding esophageal varices. Conclusion: Women with cirrhosis are at increased risk for adverse pregnancy outcomes. However, severe maternal and fetal adverse events were rare in our study, and most pregnancies in women with cirrhosis ended without complications.https://doi.org/10.1002/hep4.1255 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Hannes Hagström Jonas Höijer Hanns‐Ulrich Marschall Catherine Williamson Michael A. Heneghan Rachel H. Westbrook Jonas F. Ludvigsson Olof Stephansson |
spellingShingle |
Hannes Hagström Jonas Höijer Hanns‐Ulrich Marschall Catherine Williamson Michael A. Heneghan Rachel H. Westbrook Jonas F. Ludvigsson Olof Stephansson Outcomes of Pregnancy in Mothers With Cirrhosis: A National Population‐Based Cohort Study of 1.3 Million Pregnancies Hepatology Communications |
author_facet |
Hannes Hagström Jonas Höijer Hanns‐Ulrich Marschall Catherine Williamson Michael A. Heneghan Rachel H. Westbrook Jonas F. Ludvigsson Olof Stephansson |
author_sort |
Hannes Hagström |
title |
Outcomes of Pregnancy in Mothers With Cirrhosis: A National Population‐Based Cohort Study of 1.3 Million Pregnancies |
title_short |
Outcomes of Pregnancy in Mothers With Cirrhosis: A National Population‐Based Cohort Study of 1.3 Million Pregnancies |
title_full |
Outcomes of Pregnancy in Mothers With Cirrhosis: A National Population‐Based Cohort Study of 1.3 Million Pregnancies |
title_fullStr |
Outcomes of Pregnancy in Mothers With Cirrhosis: A National Population‐Based Cohort Study of 1.3 Million Pregnancies |
title_full_unstemmed |
Outcomes of Pregnancy in Mothers With Cirrhosis: A National Population‐Based Cohort Study of 1.3 Million Pregnancies |
title_sort |
outcomes of pregnancy in mothers with cirrhosis: a national population‐based cohort study of 1.3 million pregnancies |
publisher |
Wiley |
series |
Hepatology Communications |
issn |
2471-254X |
publishDate |
2018-11-01 |
description |
There are limited data on pregnancy outcomes in women with cirrhosis. To address this gap, we examined the records of singleton births from Sweden’s National Patient Register (NPR), Cause of Death Register (CDR), and Medical Birth Register (MBR) between 1997 and 2011 to assess exposure and pregnancy‐related and liver‐related outcomes of pregnant women with cirrhosis. Exposure status was defined as having an International Classification of Diseases (ICD) code for cirrhosis obtained prior to or during pregnancy. Poisson regression with cluster‐robust standard errors was used to estimate relative risks (RRs) adjusted for maternal age, smoking, and body mass index (BMI). We identified 103 pregnancies in women with cirrhosis and compared these to 1,361,566 pregnancies in women without cirrhosis. Pregnancies in women with cirrhosis were at increased risk of caesarean delivery (36% versus 16%, respectively; adjusted RR [aRR], 2.00; 95% confidence interval [CI], 1.47‐2.73), low birth weight (15% versus 3%; aRR, 3.87; 95% CI, 2.11‐7.06), and preterm delivery (19% versus 5%; aRR, 3.51; 95% CI, 2.16‐5.72). Rates of maternal mortality during pregnancy (no cases), gestational diabetes, preeclampsia, small for gestational age, congenital malformations, and stillbirth were not increased when compared to the pregnant women without cirrhosis. There were 12 hospitalizations during pregnancy due to liver‐related events, including one case with bleeding esophageal varices. Conclusion: Women with cirrhosis are at increased risk for adverse pregnancy outcomes. However, severe maternal and fetal adverse events were rare in our study, and most pregnancies in women with cirrhosis ended without complications. |
url |
https://doi.org/10.1002/hep4.1255 |
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