Rajput M, Kumar A. Esophageal varices in pregnancy: Strategies to optimize maternal and fetal outcomes. World J Transl Med 2026; 12(2): 120845 [DOI: 10.5528/wjtm.120845]
Corresponding Author of This Article
Adarsh Kumar, DM, MD, Associate Professor, Department of Nephrology and Renal Transplant Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar East, Near AIIMS Metro Station, New Delhi 110029, India. adarshnephro081@gmail.com
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Gastroenterology & Hepatology
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review-article
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Rajput M, Kumar A. Esophageal varices in pregnancy: Strategies to optimize maternal and fetal outcomes. World J Transl Med 2026; 12(2): 120845 [DOI: 10.5528/wjtm.120845]
World J Transl Med. Jul 28, 2026; 12(2): 120845 Published online Jul 28, 2026. doi: 10.5528/wjtm.120845
Esophageal varices in pregnancy: Strategies to optimize maternal and fetal outcomes
Meenakshi Rajput, Adarsh Kumar
Meenakshi Rajput, Department of Obstetrics and Gynaecology, Deen Dayal Upadhyay Hospital, New Delhi 110064, India
Adarsh Kumar, Department of Nephrology and Renal Transplant Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India
Author contributions: Rajput M contributed to the conception of the manuscript, literature search and review, drafting of the manuscript, and revision of the content; Kumar A contributed to the conception and design of the manuscript, supervision of the work, critical revision of the manuscript for important intellectual content, and final approval of the version to be published; Both authors contributed substantially to the manuscript, reviewed the final version, and approved it for publication.
AI contribution statement: The authors used Grammarly for language editing, grammar correction, and improvement of manuscript readability during manuscript preparation and revision. No AI-generated figures were included in the manuscript. All edits were reviewed and approved by both the authors.
Conflict-of-interest statement: Both the authors declare that they have no conflict of interest to disclose.
Corresponding author: Adarsh Kumar, DM, MD, Associate Professor, Department of Nephrology and Renal Transplant Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar East, Near AIIMS Metro Station, New Delhi 110029, India. adarshnephro081@gmail.com
Received: March 10, 2026 Revised: June 16, 2026 Accepted: July 7, 2026 Published online: July 28, 2026 Processing time: 141 Days and 19.6 Hours
Abstract
Portal hypertension during pregnancy poses risks for the mother and fetus due to changes in blood flow dynamics, progression of varices, and potential for hepatic failure. Given the limited studies involving pregnant women, current clinical guidelines are largely based on research conducted in non-pregnant populations and from considerable clinical experience. Preconception counseling and early risk assessment are essential, focusing on the severity of liver disease. Ideally, upper gastrointestinal endoscopy should be performed before conception in women with known portal hypertension. If this has not been done, the second trimester is considered the safest time for endoscopy, provided there is a strong clinical reason, minimal sedation is used, and appropriate maternal positioning is maintained. For primary prophylaxis, non-selective beta-blocker (NSBB) is recommended; endoscopic variceal ligation is an alternative if NSBBs are contraindicated or not tolerated. Optimal management requires a multidisciplinary team that includes a hepatologist, a high-risk obstetrician, an anesthesiologist, a neonatologist, and a critical care specialist, preferably within a specialized medical center. This review consolidates existing information regarding surveillance strategies and preventive interventions for esophageal varices during pregnancy, highlighting the importance of optimizing outcomes for both mother and fetus through a multidisciplinary approach.
Core Tip: Portal hypertension in pregnancy poses challenges due to physiological changes in blood flow, variceal progression, and the risk of liver decompensation. Preconception counseling and early risk assessment are essential, focusing on prior variceal bleeding, variceal size, thrombocytopenia, and liver disease severity. Upper gastrointestinal endoscopy should ideally be done before conception; if not, it can be safely performed in the second trimester when clinically indicated, with minimal sedation and proper maternal positioning. For primary prophylaxis, non-selective beta-blocker (NSBB) is preferred, with endoscopic variceal ligation as an alternative when NSBBs are contraindicated or not tolerated. Optimal care requires a multidisciplinary team in a specialized center. Current hepatology guidelines provide limited pregnancy-specific recommendations; this review consolidates the available evidence with existing clinical experience in managing portal hypertension during pregnancy.
