Maternal and Neonatal Outcomes of Liver Disease in Pregnancy: Clinical and Laboratory Predictors in a Retrospective Cohort from Indonesia

Liver disease in pregnancy causes high morbidity in low-resource settings, yet Southeast Asian data are scarce. We evaluated outcomes and identified mortality predictors in an Indonesian referral cohort. A retrospective cohort study of 181 pregnant women with liver disease (189 neonates) at a tertiary hospital in Indonesia (2010–2023). Diagnoses included hepatitis, acute fatty liver of pregnancy (AFLP), HELLP syndrome, and others. Clinical characteristics, laboratory parameters, and outcomes were extracted from records. Logistic regression was applied to identify predictors of maternal and neonatal mortality. Overall maternal mortality was 26.5%, and neonatal mortality was 41%. AFLP carried the highest maternal (37%) and neonatal (70%) mortality. Independent predictors of maternal death according to multivariable model were leukocytosis (OR 1.01, 95% CI 1.00–1.03, p = 0.041), thrombocytopenia (OR 0.88, 95% CI 0.80–0.97, p = 0.010), and elevated serum creatinine (OR 1.25, 95% CI 1.02–1.58, p = 0.032). Predictors of neonatal death included lower gestational age at delivery (OR 0.86, 95% CI 0.78–0.94, p = 0.002), lower birth weight (OR 0.91, 95% CI 0.85–0.96, p = 0.004), Apgar score < 7 (OR 2.42, 95% CI 1.30–4.50, p = 0.006), and maternal AFLP diagnosis (OR 1.75, 95% CI 1.01–3.40, p = 0.048). The multivariable model for maternal mortality demonstrated good performance (AUC 0.81, 95% CI 0.73–0.89). Liver disease in pregnancy remains associated with high maternal and neonatal mortality. Readily available clinical and laboratory markers can identify high-risk patients, supporting early referral and intensive management strategies.