{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T18:10:08Z","timestamp":1774030208150,"version":"3.50.1"},"reference-count":31,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: To evaluate the impact of liver cirrhosis on pregnancy outcomes using a large-scale, propensity score-matched cohort, with adjustment for numerous confounding variables. Materials and Methods: From a total of 3,701,876 pregnancies (women aged 18\u201349) from 1 January 2010, to 31 December 2024, after propensity score matching, 2498 pregnancies with cirrhosis and 2498 pregnancies without cirrhosis in TrinetX database were included in our analysis. To adjust for potential confounding, pregnancies in the cirrhosis group were matched 1:1 to those without cirrhosis using propensity scores derived from demographic, lifestyle, comorbidity, and laboratory characteristics. Relative risks (RRs), risk differences (RDs), and corresponding 95% confidence intervals (CIs) were calculated for pregnancy-related outcomes. Subgroup analyses stratified by maternal age were further performed to assess potential effect modification. Main outcomes included Gestational diabetes mellitus, preeclampsia, premature rupture membranes, preterm birth, miscarriage, stillbirth, placental abruption, dystocia, postpartum hemorrhagia, and cesarean delivery. Results: After matching, 2485 women were included in each group, with well-balanced baseline characteristics. Compared with women without cirrhosis, those with cirrhosis had a higher risk of pregnancy-related outcomes, including gestational diabetes mellitus (15.5% vs. 11.9%; RR = 1.30; 95% CI, 1.13\u20131.50, p &lt; 0.001), preeclampsia (8.6% vs. 5.7%; RR = 1.52; 95% CI, 1.24\u20131.87, p &lt; 0.001), and preterm birth (9.0% vs. 4.9%; RR = 1.85; 95% CI, 1.49\u20132.29, p &lt; 0.001). Cirrhosis during pregnancy was also associated with a higher risk of miscarriage (6.6% vs. 4.8%), stillbirth (1.3% vs. 0.5%), placental abruption (1.8% vs. 0.8%), postpartum hemorrhage (6.9% vs. 4.3%), and cesarean delivery (20% vs. 17.2%). The limitations include the lack of detailed data on cirrhosis severity. Conclusions: Pregnancy with liver cirrhosis is associated with increased risks of diverse maternal and neonatal complications. Our findings highlight the importance of multidisciplinary management and individualized care planning in order to reduce adverse outcomes.<\/jats:p>","DOI":"10.3390\/medicina62030591","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T17:02:43Z","timestamp":1774026163000},"page":"591","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Liver Cirrhosis on Pregnancy Outcomes: A Retrospective Cohort Study from the TriNetX Global Collaborative Network"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-0495-7686","authenticated-orcid":false,"given":"Ji-Ze","family":"Hsu","sequence":"first","affiliation":[{"name":"Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien 970, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5105-068X","authenticated-orcid":false,"given":"Dah-Ching","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien 970, Taiwan"},{"name":"Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1644","DOI":"10.1111\/1471-0528.17156","article-title":"Pregnancy in Women with Liver Cirrhosis Is Associated with Increased Risk for Complications: A Systematic Review and Meta-Analysis of the Literature","volume":"129","author":"Scholten","year":"2022","journal-title":"Int. J. Obstet. Gynaecol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Tan, Z., Zhang, P., Zhou, J., Li, C., Xu, C., and Yin, Y. (2024). Outcomes of Pregnancies Complicated by Cirrhosis: A Retrospective Cohort Study. BMC Pregnancy Childbirth, 24.","DOI":"10.1186\/s12884-024-06341-1"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Gao, X., Zhu, Y., Liu, H., Yu, H., and Wang, M. (2021). Maternal and Fetal Outcomes of Patients with Liver Cirrhosis: A Case-Control Study. BMC Pregnancy Childbirth, 21.","DOI":"10.1186\/s12884-021-03756-y"},{"key":"ref_4","first-page":"146","article-title":"Preexisting Liver Disease and Pregnancy: Optimizing Care to Optimize Outcomes","volume":"37","author":"Ergenc","year":"2026","journal-title":"Turk. J. Gastroenterol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Dokmak, A., Trivedi, H.D., Bonder, A., and Wolf, J. (2021). Pregnancy in Chronic Liver Disease: Before and after Transplantation. Ann. Hepatol., 26.","DOI":"10.1016\/j.aohep.2021.100557"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1177\/2050640620977034","article-title":"Management of Pregnancy in Women with Cirrhosis","volume":"9","author":"Rahim","year":"2021","journal-title":"United Eur. Gastroenterol. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1038\/s41575-020-00361-w","article-title":"Viral Hepatitis and Pregnancy","volume":"18","author":"Terrault","year":"2021","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1111\/1471-0528.18107","article-title":"Pregnancy Outcomes in Women with Liver Cirrhosis: A National Prospective Cohort Study Using the UK Obstetric Surveillance System","volume":"132","author":"Nana","year":"2025","journal-title":"Int. J. Obstet. Gynaecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.ajg.2022.01.003","article-title":"Acoustic Radiation Force Impulse to Measure Liver Stiffness and Predict Hepatic Decompensation in Pregnancy with Cirrhosis: A Cohort Study","volume":"23","author":"Elshaarawy","year":"2022","journal-title":"Arab J. Gastroenterol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Mullin, M., Djerboua, M., Sarkar, M., Lu, J., Velez, M.P., Brogly, S., Terrault, N.A., and Flemming, J.A. (2022). Pregnancy Is Not Associated with an Increased Risk of Decompensation, Transplant, or Death in Compensated Cirrhosis. Int. J. Hepatol., 2022.","DOI":"10.1155\/2022\/9985226"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1111\/liv.15511","article-title":"Importance of Complete Response for Outcomes of Pregnancy in Patients with Autoimmune Hepatitis","volume":"43","author":"Fischer","year":"2023","journal-title":"Liver Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1080\/1744666X.2022.2044307","article-title":"Autoimmune Hepatitis and Pregnancy: Considerations for the Clinician","volume":"18","author":"Chung","year":"2022","journal-title":"Expert Rev. Clin. Immunol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1016\/j.transproceed.2022.01.023","article-title":"Safe for Mother, Baby, and Graft? Pregnancy after Liver Transplant: A Single-Center Experience","volume":"54","author":"Frey","year":"2022","journal-title":"Transplant. Proc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1002\/ijgo.70453","article-title":"Post-Liver Transplantation Pregnancy Outcomes and Complications: A 17-Year Observational Study from Iran","volume":"172","author":"Shamsaeefar","year":"2026","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_15","first-page":"e94189","article-title":"Liver Cirrhosis in Pregnancy and Its Fetal Outcomes: A Prospective Case Series","volume":"17","author":"Paramamanathan","year":"2025","journal-title":"Cureus"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1002\/hep4.1470","article-title":"Liver Disease in Pregnancy: What\u2019s New","volume":"4","author":"Brady","year":"2020","journal-title":"Hepatol. Commun."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1002\/aid2.13205","article-title":"Outcomes of Pregnancy in Child A Liver Cirrhotic Patients: A Retrospective Multicenter Study","volume":"8","author":"Salman","year":"2021","journal-title":"Adv. Dig. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.1053\/j.gastro.2020.07.052","article-title":"Outcomes of Pregnant Women with Cirrhosis and Their Infants in a Population-Based Study","volume":"159","author":"Flemming","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1002\/hep4.1255","article-title":"Outcomes of Pregnancy in Mothers with Cirrhosis: A National Population-Based Cohort Study of 1.3 Million Pregnancies","volume":"2","author":"Marschall","year":"2018","journal-title":"Hepatol. Commun."},{"key":"ref_20","unstructured":"(2026, February 04). Real-World Data for the Life Sciences and Healthcare. Available online: https:\/\/trinetx.com\/."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Ludwig, R.J., Anson, M., Zirpel, H., Thaci, D., Olbrich, H., Bieber, K., Kridin, K., Dempfle, A., Curman, P., and Zhao, S.S. (2025). A Comprehensive Review of Methodologies and Application to Use the Real-World Data and Analytics Platform TriNetX. Front. Pharmacol., 16.","DOI":"10.3389\/fphar.2025.1516126"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"16","DOI":"10.21037\/atm.2018.12.10","article-title":"Big-Data Clinical Trial Collaborative Group Balance Diagnostics after Propensity Score Matching","volume":"7","author":"Zhang","year":"2019","journal-title":"Ann. Transl. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e28","DOI":"10.36290\/vnl.2021.048","article-title":"Liver Cirrhosis and Pregnancy: A Case Report and Review of Literature","volume":"67","author":"Dolina","year":"2021","journal-title":"Vnitr. Lek."},{"key":"ref_24","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","author":"Palatnik","year":"2017","journal-title":"Obstet. Gynecol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"445","DOI":"10.14309\/ajg.0000000000001590","article-title":"Pregnancies with Cirrhosis Are Rising and Associated with Adverse Maternal and Perinatal Outcomes","volume":"117","author":"Huang","year":"2022","journal-title":"Am. J. Gastroenterol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1038\/s41395-018-0181-x","article-title":"Non-Invasive Markers (ALBI and APRI) Predict Pregnancy Outcomes in Women with Chronic Liver Disease","volume":"114","author":"Gonsalkorala","year":"2019","journal-title":"Am. J. Gastroenterol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Tolunay, H.E., Ayd\u0131n, M., Cim, N., Boza, B., Dulger, A.C., and Y\u0131ld\u0131zhan, R. (2020). Maternal and Fetal Outcomes of Pregnant Women with Hepatic Cirrhosis. Gastroenterol. Res. Pract., 2020.","DOI":"10.1155\/2020\/5819819"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Nachshon, S., Hadar, E., Bardin, R., Barbash-Hazan, S., Borovich, A., Braun, M., and Shmueli, A. (2022). The Association between Chronic Liver Diseases and Preeclampsia. BMC Pregnancy Childbirth, 22.","DOI":"10.1186\/s12884-022-04827-4"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"365","DOI":"10.4103\/jdmimsu.jdmimsu_786_23","article-title":"Anesthetic Management of a Parturient with Cirrhotic Liver with Portal Hypertension Postvariceal Ligation for Emergency Cesarean Section","volume":"19","author":"Abdulla","year":"2024","journal-title":"J. Datta Meghe Inst. Med. Sci. Univ."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.1515\/jpm-2025-0190","article-title":"Liver Fibrosis Markers as Predictors of Adverse Outcomes in Pregnancy-Related Hypertensive Disorders","volume":"53","author":"Gezer","year":"2025","journal-title":"J. Perinat. Med."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Alexander, V., John, A., Benjamin, S., Akilesh, S., Rathore, S., Mathews, J., Regi, A., Beck, M., Santhanam, S., and Keshava, S.N. (2025). Non-Selective Beta Blockers Are Well Tolerated in Pregnancy with Portal Hypertension. Indian J. Gastroenterol.","DOI":"10.1007\/s12664-025-01876-3"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/3\/591\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T17:14:37Z","timestamp":1774026877000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/3\/591"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,20]]},"references-count":31,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["medicina62030591"],"URL":"https:\/\/doi.org\/10.3390\/medicina62030591","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,20]]}}}