In the Journals

Liver biopsy during pregnancy carries low risk, benefits patient care

Researchers found no association between liver biopsy during pregnancy and adverse pregnancy outcomes apart from a moderately increased risk for preterm birth and small for gestational age, according to a recently published study.

Jonas F. Ludvigsson, MD
Jonas F. Ludvigsson

“Given the lack of data on pregnancy outcome in relation to liver biopsy, we performed a nationwide population-based cohort study to examine the risk of adverse pregnancy outcomes in women undergoing liver biopsy compared with the general population,” Jonas F. Ludvigsson, MD, from the Karolinska Institutet, Stockholm, Sweden, and colleagues wrote.

Ludvigsson and colleagues compared 23 women exposed to liver biopsy during pregnancy with 1,135,985 women as controls. Of the 23 women who had a liver biopsy, 17 received a diagnosis with liver disease before pregnancy and 13 underwent liver biopsy within the first month after conception. Among the controls, 42,770 women had a diagnosis of liver disease.

Compared with 0.3% (95% CI, 0.3-0.3) of stillbirths and 5% (95% CI, 5-5) of preterm pregnancies in the control group there were no stillbirths among the biopsy group (95% CI, 0-14%) and 13% preterm pregnancies (95% CI, 3-34). The women who underwent liver biopsies gave birth an average of 10 days earlier compared with the control group and 6 days earlier than control patients with liver disease.

Thirteen percent of children born in the biopsy group were small for gestational age vs. 3% in the control group. This difference was significant when compared with all control patients (RR = 5.2; 95% CI, 1.8-14.8) and with control patient with liver disease (RR = 4.7; 95% CI, 1.3-17.2).

To rule out the influence of intrafamilial factors, the researchers compared pregnancy outcomes within the same mother and found no difference between biopsy-exposed pregnancy and sibling pregnancies for preterm birth, induction of labor, cesarean section, low Apgar score, neonatal death or cases of small for gestational age. In this comparison, researchers did observe an association between biopsy-exposed pregnancy and a 7-day shorter gestational age (95% CI, –12 to –2).

Women who underwent liver biopsy shortly before or after pregnancy were at high risk for adverse pregnancy outcomes. While data did not show a significant link between liver biopsy prior to or after pregnancy and stillbirth, small for gestational age or congenital malformations, data did show other risk factors increased, with a particularly high risk for neonatal death (RR = 5-6).

“Our data indicate that a substantial adverse effect is unlikely and we found no increase in stillbirths, although we have little data on fetal loss in early pregnancy,” the researchers concluded. “Potential excess risks should be weighed against the advantages of having a liver biopsy that may influence clinical management of the patient indirectly influencing fetal health.” – by Talitha Bennett

Disclosure: Healio.com/Hepatology was unable to confirm relevant financial disclosures at the time of publication.

Researchers found no association between liver biopsy during pregnancy and adverse pregnancy outcomes apart from a moderately increased risk for preterm birth and small for gestational age, according to a recently published study.

Jonas F. Ludvigsson, MD
Jonas F. Ludvigsson

“Given the lack of data on pregnancy outcome in relation to liver biopsy, we performed a nationwide population-based cohort study to examine the risk of adverse pregnancy outcomes in women undergoing liver biopsy compared with the general population,” Jonas F. Ludvigsson, MD, from the Karolinska Institutet, Stockholm, Sweden, and colleagues wrote.

Ludvigsson and colleagues compared 23 women exposed to liver biopsy during pregnancy with 1,135,985 women as controls. Of the 23 women who had a liver biopsy, 17 received a diagnosis with liver disease before pregnancy and 13 underwent liver biopsy within the first month after conception. Among the controls, 42,770 women had a diagnosis of liver disease.

Compared with 0.3% (95% CI, 0.3-0.3) of stillbirths and 5% (95% CI, 5-5) of preterm pregnancies in the control group there were no stillbirths among the biopsy group (95% CI, 0-14%) and 13% preterm pregnancies (95% CI, 3-34). The women who underwent liver biopsies gave birth an average of 10 days earlier compared with the control group and 6 days earlier than control patients with liver disease.

Thirteen percent of children born in the biopsy group were small for gestational age vs. 3% in the control group. This difference was significant when compared with all control patients (RR = 5.2; 95% CI, 1.8-14.8) and with control patient with liver disease (RR = 4.7; 95% CI, 1.3-17.2).

To rule out the influence of intrafamilial factors, the researchers compared pregnancy outcomes within the same mother and found no difference between biopsy-exposed pregnancy and sibling pregnancies for preterm birth, induction of labor, cesarean section, low Apgar score, neonatal death or cases of small for gestational age. In this comparison, researchers did observe an association between biopsy-exposed pregnancy and a 7-day shorter gestational age (95% CI, –12 to –2).

Women who underwent liver biopsy shortly before or after pregnancy were at high risk for adverse pregnancy outcomes. While data did not show a significant link between liver biopsy prior to or after pregnancy and stillbirth, small for gestational age or congenital malformations, data did show other risk factors increased, with a particularly high risk for neonatal death (RR = 5-6).

“Our data indicate that a substantial adverse effect is unlikely and we found no increase in stillbirths, although we have little data on fetal loss in early pregnancy,” the researchers concluded. “Potential excess risks should be weighed against the advantages of having a liver biopsy that may influence clinical management of the patient indirectly influencing fetal health.” – by Talitha Bennett

Disclosure: Healio.com/Hepatology was unable to confirm relevant financial disclosures at the time of publication.