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.