Article | Published:

Non-Invasive Markers (ALBI and APRI) Predict Pregnancy Outcomes in Women With Chronic Liver Disease

The American Journal of Gastroenterology (2018) | Download Citation

Subjects

Abstract

OBJECTIVES

Rates of pregnancy in women with cirrhosis are increasing. Risk of hepatic decompensation during pregnancy, therefore, merits tailored obstetric and hepatology care. Prognostic markers that determine pregnancy outcomes are lacking.

Methods

Medical records of women who attended hepatology clinic at King’s College Hospital with chronic liver disease (CLD) who became pregnant from 1983 to 2017 were reviewed. Information on demographics, clinical history, serology, and outcome of pregnancy was collected.

Results

In all, 165 pregnancies occurred in 100 women with CLD including 80 pregnancies in 48 women with cirrhosis. Median age of conception in cirrhotic and non-cirrhotic women were 26 years (16–44) and 28 years (16–51) respectively (p = 0.015). Whilst women with cirrhosis had similar live birth rate to non-cirrhotic women (75 vs. 85% p = 0.119), they were significantly less likely to proceed beyond 37 weeks gestation (45 vs. 58% p = 0.033). Women who received preconception counseling were more likely to have stable liver disease at conception (100 vs 86% p = 0.02). Compared with preconception MELD (model for end stage liver disease), preconception Albumin-Bilirubin score (ALBI) more accurately predicted live birth with an area under the receiver-operator curve (AUROC) of 0.741 (p < 0.001), and preconception AST to platelet ratio index (APRI) more accurately predicted ability to proceed beyond 37 weeks gestation with an AUROC of 0.700 (p < 0.001).

Conclusions

Most women with cirrhosis who conceived achieved a successful pregnancy outcome. ALBI and APRI scores can prognosticate pregnancy outcomes in women with CLD. Preconception counseling by a hepatologist or specialist obstetrician improved patient care in this group.

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Author information

Affiliations

  1. Institute of Liver Studies, King’s College Hospital, London, SE5 9RS, UK

    • Enoka S. Gonsalkorala BPhty (Hons), MBBS, FRACP
    • , Mary D. Cannon MB, MRCPI, PhD
    • , Tiong Yeng Lim MBBChir
    •  & Michael A. Heneghan MD, MMedSc, FRCPI
  2. King’s Liver Pregnancy Research Group, King’s College Hospital, London, SE5 9RS, UK

    • Enoka S. Gonsalkorala BPhty (Hons), MBBS, FRACP
    • , Mary D. Cannon MB, MRCPI, PhD
    • , Tiong Yeng Lim MBBChir
    •  & Michael A. Heneghan MD, MMedSc, FRCPI
  3. Department of Obstetrics, King’s College Hospital, London, SE5 9RS, UK

    • Leonie Penna FRCOG
  4. Division of Women’s Health, King’s College London, Guy’s Site, London, SE1 1UL, UK

    • Catherine Willliamson BSc, MB, ChB, MD

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Conflict of interest

Guarantor of the article: Michael A Heneghan.

Specific author contributions: Enoka S Gonsalkorala – planning study, conducting study, collecting and interpreting data, drafting manuscript. Mary D Cannon – planning study, conducting study, collecting, and interpreting data, Tiong Yeng Lim – planning study, conducting study, collecting, and interpreting data, Leonie Penna – planning study, Catherine Williamson – planning study, Michael A Heneghan – planning study, conducting study, interpreting data, drafting manuscript, All authors have approved the final submission.

Financial support: Michael A Heneghan is a recipient of an EASL grant for pregnancy and liver disease.

Potential competing interests: The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Michael A. Heneghan MD, MMedSc, FRCPI.

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DOI

https://doi.org/10.1038/s41395-018-0181-x