Maternal and fetal outcomes in pregnant women with liver disease

Abstract

Objective: To determine the maternal and fetal outcomes among pregnant females with liver disease.

Methodology: This prospective observational study was performed at the department of obstetrics & gynecology, Nishtar Hospital Multan, Pakistan, during August 2024 to July 2025. Pregnant females aged 20-40 years with gestational age ≥ 28 weeks, regardless of their parity or gravidity status, with liver disease, and planned to undergo delivery were analyzed. Demographic, clinical and laboratory parameters were documented. Clinical presentation, causes of liver disease, and details about the treatment were recorded. Fetal and maternal outcomes in terms of survival or death were noted.

Results: Among the 136 women, the median age, gestational age, and BMI were 29.50 (26.00-35.00) years, 36.00 (34.00-38.00) weeks, and 27.65 (25.05-30-98) kg/m2, respectively. The most common clinical presentations were jaundice, and vomiting, noted in 31 (22.8%), and 24 (17.6%) women, respectively. The most frequent causes of liver disease was intra-hepatic cholestasis, noted in (25.7%). Maternal mortality was observed in 4 (2.9%) women, and the presence of acute fatty liver disease (AFLD) was more frequent in maternal deaths (p=0.008). There were 5 (3.7%) fetal deaths, and significantly associated with acute fatty liver disease (60.0%, p=0.007).

Conclusion: The findings suggest a possible association of acute fatty liver disease with adverse maternal and fetal outcomes. Although the observed mortality rates were relatively low, careful monitoring and appropriate management of pregnant women with liver disease remain important.