From the Research
Introduction to Pregnancy in Patients with Alcoholic Liver Cirrhosis
Pregnancy in patients with alcoholic liver cirrhosis poses significant risks to both the mother and the fetus. According to 1, as the treatment of cirrhosis improves, pregnancy in patients with cirrhosis is likely to become more common, but these patients face unique risks.
Risks Associated with Pregnancy in Alcoholic Liver Cirrhosis
The risks associated with pregnancy in patients with alcoholic liver cirrhosis include:
- Higher rates of spontaneous abortion and prematurity
- Potential for life-threatening variceal hemorrhage, hepatic decompensation, splenic artery aneurysm rupture, and postpartum hemorrhage, as noted in 1 and 2
- Increased risk of maternal and fetal complications, including gestational hypertension, placental abruption, and uterovaginal hemorrhage, as reported in 2 and 3
- Increased risk of preterm delivery, caesarean section, pre-eclampsia, and small-for-gestational-age neonates, as found in 3
Management and Treatment
Management of pregnancy in patients with alcoholic liver cirrhosis requires close maternal-fetal monitoring.
- Medications must be tailored appropriately during pregnancy, as noted in 1
- Upper gastrointestinal endoscopy may be performed to screen for esophageal varices, and endoscopic band ligation may be necessary in cases of upper gastrointestinal bleeding, as reported in 4
- Delivery by caesarean section may be recommended for patients with esophageal varices to reduce the risk of bleeding, as suggested in 4
Caveats and Considerations
Pregnancy is not recommended for patients with hepatic cirrhosis due to high maternal and fetal morbidity and mortality, as stated in 4.
- The pregnancy course of cases with cirrhosis changes according to the stage of liver injury and severity of disease
- Maternal-fetal morbidity and mortality rates have been decreased by current developments in hepatology, prevention of bleeding from varices with drugs and/or band ligation, improvement in liver transplantation, and increasing experience in this issue, as noted in 4 and 5