Analysis of the course and outcomes of pregnancy in non-communicable liver diseases

BACKGROUND: Extragenital pathologies occupy a leading place in the structure of obstetric and perinatal complications. Among those are hepatobiliary diseases, which adversely affect the course and outcome of pregnancy. However, pregnancy itself is a trigger for a particular pathology, including liver and biliary tract diseases. The liver is considered the central organ of metabolic and energy homeostasis, so any change in its function is dangerous. Given that the liver is the only organ for the synthesis of albumins, fibrinogen, prothrombin, and other coagulation factors, any severe damage to its parenchyma, for example, in preeclampsia, can lead to catastrophic consequences. Possessing a multifunctional potential, the hepatobiliary system, when damaged, reacts with a wide variety of pathological processes. Therefore, it should be studied to determine pregnancy management tactics and the methods of delivery.

AIM: The aim of this study was to assess the outcomes of pregnancy and childbirth in hepatobiliary pathology associated with pregnancy and chronic non-communicable liver pathology.

METHODS: This cross-sectional multicenter study included pregnant women with or without non-communicable liver diseases. Two main groups (I and II) consisted of pregnant women with hepatobiliary pathology, associated with pregnancy and complicated by preeclampsia and liver dysfunction, as well as intrahepatic cholestasis of pregnancy. Two comparison groups (III and IV) consisted of pregnant women with hepatic steatosis and normal pregnancy. We compared incidences of maternal and perinatal complications, as well as methods of delivery for different types of hepatopathy, with associations between diseases and outcomes being identified.

RESULTS: This study included 263 pregnant women. In the preeclampsia group, there was a high incidence of maternal and perinatal complications. In this group, the delivery period was 34.00 [31.00; 37.00] weeks; in 74% of cases, delivery was premature; in 94% of cases, operative delivery was performed; and in 28% of cases, neonatal asphyxia was diagnosed. In the groups with intrahepatic cholestasis of pregnancy and hepatic steatosis, we also found a high rate of abdominal delivery (56 and 83%, respectively). In the group with intrahepatic cholestasis of pregnancy, every third newborn was diagnosed with fetal growth restriction. In the hepatic steatosis group, the course of the neonatal period was complicated by hypoglycemia due to prematurity and impaired carbohydrate metabolism in the mother.

CONCLUSION: Hepatobiliary diseases adversely affect the course and outcome of pregnancy, particularly in the case of hepatopathy associated with gestation. In some cases, pregnancy itself triggers the onset of liver pathology due to the load exerted on the hepatobiliary system. The high incidence of maternal and perinatal complications associated with this condition increases the frequency of operative delivery.