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

Gonsalkorala, Enoka S., BPhty (Hons), MBBS, FRACP1,2; Cannon, Mary D., MB, MRCPI, PhD1,2; Lim, Tiong Yeng, MBBChir1,2; Penna, Leonie, FRCOG3; Willliamson, Catherine, BSc, MB, ChB, MD4; Heneghan, Michael A., MD, MMedSc, FRCPI1,2

American Journal of Gastroenterology: February 2019 - Volume 114 - Issue 2 - p 267–275
doi: 10.1038/s41395-018-0181-x
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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.

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

2King’s Liver Pregnancy Research Group, King’s College Hospital, London SE5 9RS, UK;

3Department of Obstetrics, King’s College Hospital, London SE5 9RS, UK;

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

Correspondence: Michael A. Heneghan, MD, MMedSc, FRCPI. E-mail: michael.heneghan@nhs.net.

Received December 17, 2018

Accepted May 29, 2018

© The American College of Gastroenterology 2019. All Rights Reserved.
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