Introduction
Pregnancy is a rare event in women with liver cirrhosis in part due to
decreased natural fertility rates. 1,2 The prevalence
of cirrhosis in women of reproductive age is 0.045%.3 The incidence of cirrhosis in pregnancy is reported
as approximately 1 per 4500 pregnancies. 4, 5Worldwide, the most common causes of liver cirrhosis in women are viral
hepatitis, autoimmune hepatitis, alcoholic liver disease and non-alcohol
related fatty liver disease. 1 Although pregnancy and
cirrhosis is a rare combination, it appears to have become more frequent
in the last decades possibly owing to improvements in the treatment of
liver cirrhosis, increased awareness of cirrhosis after the introduction
of screening in high risk populations, and the availability of assisted
reproductive techniques. 6-8 For clinicians and
patients alike, when deciding on family planning and obstetric
management, the effects of liver cirrhosis on the course of pregnancy
and the effects of pregnancy on underlying cirrhosis are both of
importance.
Previous studies have shown that pregnancy in women with cirrhosis is
associated with a high risk of complications, including maternal and
perinatal mortality. 3,9 However, studies are small
and report on a variety of outcomes. 5, 10-14 This
makes it difficult to advise both patients with liver cirrhosis and
their clinicians on the course of a planned pregnancy. A systematic
review and meta-analysis of the literature could provide with robust
estimates of the risks involved in pregnancy. Here, we provide a
systematic review reporting on the maternal, fetal and obstetric
complications among pregnant women with liver cirrhosis.