Outcomes of liver diseases in pregnant females: A study from a tertiary care medical center in Pakistan

Nazish Butt; Sabir Ali; Haleema Yasmeen; Khalid Mumtaz

doi:10.12669/pjms.40.3.7670

Outcomes of liver diseases in pregnant females: A study from a tertiary care medical center in Pakistan

Pak J Med Sci. 2024 Jan-Feb;40(3Part-II):284-290. doi: 10.12669/pjms.40.3.7670.

Authors

Nazish Butt¹, Sabir Ali², Haleema Yasmeen³, Khalid Mumtaz⁴

Affiliations

¹ Nazish Butt, FCPS. Gastroenterology Department, Jinnah Postgraduate Medical Centre, Karachi, Pakistan.
² Sabir Ali, MBBS. Gastroenterology Department, Jinnah Postgraduate Medical Centre, Karachi, Pakistan.
³ Haleema Yasmeen, FCPS. Gastroenterology Department, Jinnah Postgraduate Medical Centre, Karachi, Pakistan.
⁴ Khalid Mumtaz, FCPS (Med), FCPS (GI), MSc Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University, Columbus, United States.

Abstract

Objective: To determine the etiologies and outcomes of liver disease in pregnancy in a developing country.

Method: A total of 336 consecutive pregnant women with liver disease were included in this prospective cohort study conducted at the Department of Gastroenterology, Jinnah Postgraduate Medical Center, Karachi from August 2019 to August 2021. Patients' baseline demographic, clinical, and laboratory data and outcomes were collected on a pre-designed questionnaire.

Results: Among all the pregnant females, the most common liver disease was acute hepatitis E virus (HEV) infection (37.2%), followed by preeclampsia (PEC)/eclampsia (EC), hemolysis, elevated liver enzymes & low platelets (HELLP) syndrome, and hyperemesis gravidarum (HG). The most common maternal complications were fulminant hepatic failure (FHF) in 14.9% and placental abruption in 11.0%. Fetal complications included intrauterine death (IUD) in 20.8% and preterm birth in 8.6%. The maternal and neonatal mortality rates were 11.6% and 39.6%, respectively. Among the predictors, low maternal weight, low body mass index (BMI), and low hemoglobin (Hb) were associated with increased maternal mortality. Low fetal weight, height, maternal systolic blood pressure (SBP), and low maternal Hb were independent predictors of fetal mortality.

Conclusion: In our cohort of pregnant females in a tertiary care medical center, acute HEV was the most common liver disease, followed by PEC/EC, HELLP, and HG. Maternal and fetal deaths were alarming in this group of patients and demanded careful management.

Keywords: Etiology; Fetal Complications; Fetal Mortality; Fulminant Hepatic Failure; HELLP; HEV; Liver Diseases; Maternal Complications; Maternal Mortality; Pregnancy.