TY - JOUR
T1 - Impact of Cirrhosis and Liver Transplant on Maternal Health During Labor and Delivery
AU - Murthy, Sanjay K.
AU - Heathcote, E. Jenny
AU - Nguyen, Geoffrey C.
N1 - Funding Information:
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 Survey, supporting data reliability. 9
PY - 2009/12
Y1 - 2009/12
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=70849124816&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=70849124816&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2009.08.008
DO - 10.1016/j.cgh.2009.08.008
M3 - Article
C2 - 19686866
AN - SCOPUS:70849124816
SN - 1542-3565
VL - 7
SP - 1367-1372.e1
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 12
ER -