{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T22:08:10Z","timestamp":1792015690104,"version":"4.4.0"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","license":[{"start":{"date-parts":[[2018,9,25]],"date-time":"2018-09-25T00:00:00Z","timestamp":1537833600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Hepatology Communications"],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:p>There are limited data on pregnancy outcomes in women with cirrhosis. To address this gap, we examined the records of singleton births from Sweden\u2019s National Patient Register (NPR), Cause of Death Register (CDR), and Medical Birth Register (MBR) between 1997 and 2011 to assess exposure and pregnancy\u2010related and liver\u2010related outcomes of pregnant women with cirrhosis. Exposure status was defined as having an International Classification of Diseases (ICD) code for cirrhosis obtained prior to or during pregnancy. Poisson regression with cluster\u2010robust standard errors was used to estimate relative risks (RRs) adjusted for maternal age, smoking, and body mass index (BMI). We identified 103 pregnancies in women with cirrhosis and compared these to 1,361,566 pregnancies in women without cirrhosis. Pregnancies in women with cirrhosis were at increased risk of caesarean delivery (36% versus 16%, respectively; adjusted RR [aRR], 2.00; 95% confidence interval [CI], 1.47\u20102.73), low birth weight (15% versus 3%; aRR, 3.87; 95% CI, 2.11\u20107.06), and preterm delivery (19% versus 5%; aRR, 3.51; 95% CI, 2.16\u20105.72). Rates of maternal mortality during pregnancy (no cases), gestational diabetes, preeclampsia, small for gestational age, congenital malformations, and stillbirth were not increased when compared to the pregnant women without cirrhosis. There were 12 hospitalizations during pregnancy due to liver\u2010related events, including one case with bleeding esophageal varices<jats:italic toggle=\"yes\">. Conclusion:<\/jats:italic> Women with cirrhosis are at increased risk for adverse pregnancy outcomes. However, severe maternal and fetal adverse events were rare in our study, and most pregnancies in women with cirrhosis ended without complications.<\/jats:p>","DOI":"10.1002\/hep4.1255","type":"journal-article","created":{"date-parts":[[2018,9,25]],"date-time":"2018-09-25T16:31:11Z","timestamp":1537893071000},"page":"1299-1305","source":"Crossref","is-referenced-by-count":72,"title":["Outcomes of Pregnancy in Mothers With Cirrhosis: A National Population\u2010Based Cohort Study of 1.3 Million Pregnancies"],"prefix":"10.1097","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8474-1759","authenticated-orcid":false,"given":"Hannes","family":"Hagstr\u00f6m","sequence":"first","affiliation":[{"name":"Center for Digestive Diseases, Division of Hepatology,Karolinska University Hospital,Stockholm,Sweden"},{"name":"Clinical Epidemiology Unit, Department of Medicine,Solna, Karolinska Institute,Stockholm,Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"H\u00f6ijer","sequence":"additional","affiliation":[{"name":"Unit of Biostatistics, Institute of Environmental Medicine,Karolinska Institute,Stockholm,Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanns\u2010Ulrich","family":"Marschall","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Medicine and Wallenberg Laboratory, Institute of Medicine,Sahlgrenska Academy, University of Gothenburg,Gothenburg,Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Williamson","sequence":"additional","affiliation":[{"name":"Department of Women and Children\u2019s Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Heneghan","sequence":"additional","affiliation":[{"name":"Institute of Liver Studies,King\u2019s College Hospital,London,United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel H.","family":"Westbrook","sequence":"additional","affiliation":[{"name":"Sheila Sherlock Liver Unit,Royal Free Hospital,London,United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas F.","family":"Ludvigsson","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics,Karolinska Institute,Stockholm,Sweden"},{"name":"Department of Pediatrics,\u00d6rebro University Hospital, \u00d6rebro University,\u00d6rebro,Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olof","family":"Stephansson","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit, Department of Medicine,Solna, Karolinska Institute,Stockholm,Sweden"},{"name":"Department of Women\u2019s and Children\u2019s Health,Karolinska Institute,Stockholm,Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,9,25]]},"reference":[{"key":"hep41255-bib-0001-20240114","first-page":"1","article-title":"Deaths: preliminary data for 2009","volume":"59","year":"2011","journal-title":"NVSS"},{"key":"hep41255-bib-0002-20240114","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/S0146-0005(98)80048-7","article-title":"Cirrhosis and portal hypertension in pregnancy","volume":"22","year":"1998","journal-title":"Semin Perinatol"},{"key":"hep41255-bib-0003-20240114","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1016\/S0140-6736(09)61495-1","article-title":"Liver disease in pregnancy","volume":"375","year":"2010","journal-title":"Lancet"},{"key":"hep41255-bib-0004-20240114","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1136\/gut.32.2.202","article-title":"Amenorrhoea in women with non\u2010alcoholic chronic liver disease","volume":"32","year":"1991","journal-title":"Gut"},{"key":"hep41255-bib-0005-20240114","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1111\/j.1478-3231.2009.02153.x","article-title":"The outcomes of pregnancy in patients with cirrhosis: a population\u2010based study","volume":"30","year":"2010","journal-title":"Liver Int"},{"key":"hep41255-bib-0006-20240114","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/0002-9610(82)90190-8","article-title":"Pregnancy and esophageal varices","volume":"143","year":"1982","journal-title":"Am J Surg"},{"key":"hep41255-bib-0007-20240114","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1136\/gut.22.7.592","article-title":"Pregnancy and liver disease","volume":"22","year":"1981","journal-title":"Gut"},{"key":"hep41255-bib-0008-20240114","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1016\/j.cgh.2011.03.036","article-title":"Model for end\u2010stage liver disease score predicts outcome in cirrhotic patients during pregnancy","volume":"9","year":"2011","journal-title":"Clin Gastroenterol Hepatol"},{"key":"hep41255-bib-0009-20240114","doi-asserted-by":"crossref","first-page":"J239","DOI":"10.1016\/j.jaut.2011.12.002","article-title":"Outcomes of pregnancy in women with autoimmune hepatitis","volume":"38","year":"2012","journal-title":"J Autoimmun"},{"key":"hep41255-bib-0010-20240114","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.gtc.2016.02.010","article-title":"Women with cirrhosis: prevalence, natural history, and management","volume":"45","year":"2016","journal-title":"Gastroenterol Clin North Am"},{"key":"hep41255-bib-0011-20240114","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1097\/AOG.0000000000002055","article-title":"Medical and obstetric complications among pregnant women with liver cirrhosis","volume":"129","year":"2017","journal-title":"Obstet Gynecol"},{"key":"hep41255-bib-0012-20240114","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.ijgo.2012.12.020","article-title":"Prognosis and determinants of pregnancy outcome among patients with post\u2010hepatitis liver cirrhosis","volume":"121","year":"2013","journal-title":"Int J Gynaecol Obstet"},{"key":"hep41255-bib-0013-20240114","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1007\/s10654-009-9350-y","article-title":"The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research","volume":"24","year":"2009","journal-title":"Eur J Epidemiol"},{"key":"hep41255-bib-0014-20240114","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1186\/1471-2458-11-450","article-title":"External review and validation of the Swedish national inpatient register","volume":"11","year":"2011","journal-title":"BMC Public Health"},{"key":"hep41255-bib-0015-20240114","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1007\/s10654-017-0316-1","article-title":"The Swedish cause of death register","volume":"32","year":"2017","journal-title":"Eur J Epidemiol"},{"key":"hep41255-bib-0016-20240114","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1111\/j.1651-2227.1996.tb14164.x","article-title":"Intrauterine growth curves based on ultrasonically estimated foetal weights","volume":"85","year":"1996","journal-title":"Acta Paediatr"},{"key":"hep41255-bib-0017-20240114","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1177\/0962280211427759","article-title":"Extension of the modified Poisson regression model to prospective studies with correlated binary data","volume":"22","year":"2013","journal-title":"Stat Methods Med Res"},{"key":"hep41255-bib-0018-20240114","first-page":"491","article-title":"Ethical aspects of registry\u2010based research in the Nordic countries","volume":"7","year":"2015","journal-title":"Clin Epidemiol"},{"key":"hep41255-bib-0019-20240114","doi-asserted-by":"crossref","first-page":"797","DOI":"10.3109\/00365521.2015.1036359","article-title":"Liver transplantation in the Nordic countries \u2010 an intention to treat and post\u2010transplant analysis from The Nordic Liver Transplant Registry 1982\u20132013","volume":"50","year":"2015","journal-title":"Scand J Gastroenterol"},{"key":"hep41255-bib-0020-20240114","doi-asserted-by":"crossref","first-page":"506","DOI":"10.3109\/14767058.2015.1009438","article-title":"Outcomes of pregnancies complicated by liver cirrhosis, portal hypertension, or esophageal varices","volume":"29","year":"2016","journal-title":"J Matern Fetal Neonatal Med"}],"container-title":["Hepatology Communications"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fhep4.1255","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hep4.1255","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hep4.1255","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/02009842-201811000-00004","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,14]],"date-time":"2024-01-14T16:07:46Z","timestamp":1705248466000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/02009842-201811000-00004"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,9,25]]},"references-count":20,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.1002\/hep4.1255","relation":{},"ISSN":["2471-254X","2471-254X"],"issn-type":[{"value":"2471-254X","type":"print"},{"value":"2471-254X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,9,25]]}}}