The association between chronic liver diseases and preeclampsia

Sapir Nachshon; Eran Hadar; Ron Bardin; Shiri Barbash-Hazan; Adi Borovich; Marius Braun; Anat Shmueli

doi:10.1186/s12884-022-04827-4

The association between chronic liver diseases and preeclampsia

BMC Pregnancy Childbirth. 2022 Jun 20;22(1):500. doi: 10.1186/s12884-022-04827-4.

Authors

Sapir Nachshon¹, Eran Hadar^{1

2}, Ron Bardin^{1

2}, Shiri Barbash-Hazan^{1

2}, Adi Borovich^{1

2}, Marius Braun^{1

3}, Anat Shmueli^{4

5}

Affiliations

¹ Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
² Rabin Medical Center, Helen Schneider Hospital for Women, Beilinson Hospital, 39 Jabotinski St, 4941492, Petach Tikva, Israel.
³ Liver Institute, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.
⁴ Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. anatshmu79@gmail.com.
⁵ Rabin Medical Center, Helen Schneider Hospital for Women, Beilinson Hospital, 39 Jabotinski St, 4941492, Petach Tikva, Israel. anatshmu79@gmail.com.

Abstract

Background: Preeclampsia is a multisystem disorder characterized by an abnormal vascular response to placentation associated with increased systemic vascular resistance. As liver involvement is one of the main clinical features of preeclampsia, we sought to determine if there is an association between chronic liver diseases and preeclampsia.

Methods: A retrospective matched case-control analysis was conducted in a tertiary medical center. Three hundred eleven (311) pregnant women with preexisting chronic liver disease (study group), including viral and autoimmune hepatitis, non-alcoholic fatty liver, Wilson disease, and cirrhosis, were match for age, parity, and number of fetuses to 933 healthy pregnant women (control group). The primary outcome measure was the incidence of preeclampsia in each group. Secondary outcome measures were obstetrical and neonatal complications. Confounders found to be significant on univariate analysis were evaluated using logistic regression models, and odds ratios (OR) and confidence intervals (CI) were calculated.

Results: Preeclampsia was diagnosed in 28 women (9.0%) in the study group and 33 women (3.54%) in the control group (p < 0.001). On multivariate analysis adjusted for maternal age, parity, previous preeclampsia, chronic hypertension, gestational diabetes mellitus, pregestational diabetes mellitus, antiphospholipid syndrome, and mode of conception, chronic liver disease was found to be an independent risk factor for preeclampsia (aOR 2.631, 95% CI 1.518-4.561). Although there was no difference in the gestational week at delivery between the groups (38.6 ± 2.13 vs. 38.8 ± 2.17 for study and control group, respectively, p = 0.410), the study group had a lower mean neonatal birthweight (3088 ± 551 vs. 3182 ± 566 g, p = 0.011). There were no between-group differences in the other parameters evaluated.

Conclusion: In our study, preexisting chronic liver disease was associated with a 2.6-fold increased risk of preeclampsia.

Keywords: Chronic Liver Disease; Hypertension; Preeclampsia.

MeSH terms

Diabetes, Gestational*
Female
Humans
Infant, Newborn
Liver Diseases* / epidemiology
Maternal Age
Pre-Eclampsia* / diagnosis
Pre-Eclampsia* / epidemiology
Pregnancy
Retrospective Studies
Risk Factors