Epidemiologic Trends in Acute, Chronic, and Pregnancy-Specific Liver Diseases in Pregnancy.
Academic Article
Overview
abstract
BACKGROUND: Chronic liver diseases (CLD) and cirrhosis are rising in reproductive-aged female patients, primarily driven by increasing alcohol-related liver disease (ALD) and metabolic dysfunction-associated steatotic liver disease (MASLD). However, contemporary data on acute, chronic, and pregnancy-specific liver diseases remain limited. METHODS: This ten-year retrospective study at a tertiary center included all pregnancies from January 1, 2014, to December 31, 2023. Liver conditions - categorized as acute, chronic and pregnancy-specific - were identified by diagnosis codes. Sociodemographic and pregnancy-related data were collected from electronic medical records. Group comparisons were performed using the chi-square and Student's t-tests. Temporal trends were assessed via the Cochrane-Armitage test. RESULTS: Among 51,708 pregnancies, 1,429 (2.8%) were affected by one or more liver condition: 85 (4.8%) with acute, 913 (51.8%) with CLD [including 77 (4.4%) with cirrhosis], and 784 (44.5%) with pregnancy-specific liver diseases, [e.g., intrahepatic cholestasis of pregnancy (ICP), acute fatty liver of pregnancy (AFLP), hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, and preeclampsia with liver involvement]. Prevalent CLD in pregnancy increased over time, with a shift from chronic viral hepatitis to metabolic dysfunction-associated liver disease (MASLD) (p values <0.01). Pregnancy-specific liver conditions remained stable over time, though occurred more commonly in those with concurrent CLD (ICP 3.2% vs. 0.6%, preeclampsia 11.3% vs. 6.3%, HELLP syndrome 0.6% vs 0.2% and AFLP 0.2% vs. 0.0%,; all p <0.01). CONCLUSION: In this large epidemiologic study, we observed a 2.5-fold rise in CLD in pregnancy over the past 10 years, largely driven by the rising prevalence of MASLD, and declining prevalence of chronic viral hepatitis. Pregnancy-specific liver conditions were also significantly more common in those with CLD. Findings underscore the relevance of pre-conception counseling by hepatology providers and the importance of early obstetric collaboration to optimize outcomes for the growing number of pregnant women with pre-existing liver disease.
