Outcomes of Liver Diseases in Pregnant Females: A Study from a Large Tertiary Care Medical Center in Pakistan.

Abstract Purpose: Liver diseases are uncommon in pregnant females but challenging to manage. The present study aimed to determine the etiologies and outcomes of liver disease in pregnancy in a developing country. Methodology: We included a total of 336 consecutive pregnant women with liver disease seen at the Department of Gastroenterology, Jinnah Postgraduate Medical Center from August 2019 to August 2021. Patients’ baseline demographic, clinical, and laboratory data and outcomes were collected on a pre-designed questionnaire. Results: Among all the pregnant females, the most common liver disease was acute hepatitis E virus (HEV) infection (37.2%), followed by preeclampsia/eclampsia, hemolysis, elevated liver enzymes & low platelets (HELLP) syndrome, and hyperemesis gravidarum (HG). The most common maternal complications were a fulminant hepatic failure (FHF) in 14.9% and placental abruption in 11.0%. Fetal complications included intrauterine death (IUD) in 20.8% and preterm birth in 8.6%. The maternal and neonatal mortality rates were 11.6% and 39.6%, respectively. Among the predictors, low maternal weight, low body mass index (BMI), low hemoglobin (Hb), were associated with the increased maternal mortality. Low fetal weight, height, low maternal systolic blood pressure (SBP), low maternal Hb were the independent predictors of fetal mortality. Conclusion: In our cohort of pregnant females in a tertiary care medical center, acute HEV was the most common liver disease, followed by preeclampsia/eclampsia, HELLP, and HG. Maternal and fetal deaths were alarming in this group of patients and demand careful management.