Work

Quantifying a Neglected Burden: Pregnancy-Associated Hepatocellular Carcinoma and Maternal Death in South Africa

Year: 2026

Type: article

Abstract: PURPOSE: Hepatocellular carcinoma (HCC) during pregnancy is rare, with the literature confined to isolated case reports and small series. Women in sub-Saharan Africa (SSA) face disproportionate risk due to chronic hepatitis B virus (HBV) infection acquired perinatally, HCC in noncirrhotic livers at a young age, and fertility rates nearly three times those of Europe. To our knowledge, we report the largest cohort of pregnancy-associated HCC from SSA, drawn from a single South African center, and the first quantitative estimate of regional disparity versus Europe. METHODS: Pregnant women with HCC at Groote Schuur Hospital, Cape Town, over 24 years (2001-2025) were identified from a prospectively maintained registry. A model integrating HCC incidence, age-at-diagnosis, fertility rates, and 1-year mortality compared the probability of pregnancy-associated HCC and maternal death in SSA versus Europe. RESULTS: Of the 728 registry patients, 192 (26.4%) were female and 10 (5.2%) were pregnant or within 1 year postpartum. The median age was 32.5 (IQR, 28.5-35.3), 70% had chronic HBV infection, and three had cirrhosis. Seven (70%) died, six within 90 days. Two patients survived beyond 10 years following curative resection. Four pregnancies ended in intrauterine fetal demise and five in live births. The modeled probability of pregnancy-associated HCC was 16 per 100,000 women in SSA versus 0.14 per 100,000 in Europe-a 114-fold difference-with a 187-fold greater risk of maternal death. CONCLUSION: Pregnancy-associated HCC in SSA is a quantifiable, preventable contributor to maternal mortality-nearly two orders of magnitude greater than in Europe. HBV endemicity, early-onset noncirrhotic HCC, and high fertility rates create a hostile environment for women of reproductive age. HBV-aware liver surveillance in antenatal care, strengthened prevention of mother-to-child transmission programs, and improved maternal mortality data systems are urgently needed.

Source: JCO Global Oncology

DOI: 10.1200/go-26-00330