Most women with liver disease can become pregnant, have uncomplicated pregnancies, and go on to give birth to healthy babies. However, in some circumstances- decompensated cirrhosis, liver disease may adversely affect pregnancy and childbirth.

Cirrhosis is often associated with amenorrhea (lack of menses) and infertility. Consequently, women with cirrhosis—especially decompensated cirrhosis—may have difficulty conceiving. As a result of their advanced liver disease, women with decompensated cirrhosis who do conceive have an increased risk of serious complications during pregnancy. Approximately 15 to 20 percent of these women suffer spontaneous abortion (miscarriage). Also, there is an increased risk for premature childbirth or stillbirth. Furthermore, women with decompensated cirrhosis are at an increased risk for the development of liver failure during pregnancy, although it is unknown how often this occurs.

Bleeding from esophageal varices is probably the biggest pregnancy-related health risk for women with decompensated cirrhosis. Variceal bleeding is most common during the second trimester, occurring in approximately 20 to 45 percent of women with portal hypertension. Ten percent of the time, women with decompensated cirrhosis experience variceal bleeding during labor and immediately after childbirth. Death of the mother from uncontrollable variceal hemorrhage occurs approximately 10 to 18 percent of the time during the course of pregnancy. Depending on the trimester, the baby may nevertheless have  chance for survival. Women with decompensated cirrhosis who are thinking about becoming pregnant should undergo an upper endoscopy, which can assess the presence and degree of esophageal varices. If a woman has esophageal varices, she should be placed on a beta-blocker, such as propanolol (Inderal). It should be kept in mind that beta-blockers may pose risks to a fetus, including a slow heart rate and potential growth retardation. Such risks must be weighed against the potential benefit to be gained by preventing bleeding from esophageal varices. Women who have previously bled from esophageal varices are advised to refrain from becoming pregnant. For these women, if pregnancy is still desired despite the high risks, it is recommended that a transjugular intrahepatic portosystemic shunt (TIPS) or other shunt procedure be considered before pregnancy occurs—as this may decrease the risk of bleeding from esophageal varices. It has been noted that for pregnant women with  chronic liver disease, those with alcoholic cirrhosis appear to have the worst prognosis. Those with primary biliary cirrhosis appear to have the best prognosis.

Despite the increased risk of complications, many women with decompensated cirrhosis successfully proceed through pregnancy and childbirth without any complications. It is important for these women to be monitored regularly by a liver specialist and to choose an obstetrician who has experience with high-risk pregnancies. Fetuses should be very closely monitored during pregnancy.  If there are signs of fetal distress or if bilirubin levels become very high in the mother, early delivery should be considered.  Infants born alive generally do very well.