Quantifying a Neglected Burden: Pregnancy-Associated Hepatocellular Carcinoma and Maternal Death in South Africa
4 affiliations
- 1Division of Surgical Gastroenterology, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- 2Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- 3Division of Radiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- 4Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Abstract
PurposeHepatocellular 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.MethodsPregnant 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.ResultsOf 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.ConclusionPregnancy-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.
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BibTeX
@article{venter2026quantifying,
title = {{Quantifying a Neglected Burden: Pregnancy-Associated Hepatocellular Carcinoma and Maternal Death in South Africa}},
author = {Keith Venter and Sanju Sobnach and Urda Kotze and Inae Kim and C. Wendy Spearman and Mark Sonderup and Neliswa Gogela and Dale Creamer and Ayesha Osman and Leann Schoeman and Marc Bernon and Eduard Jonas},
journal = {JCO Global Oncology},
year = {2026},
month = nov,
doi = {10.1200/go-26-00330},
url = {https://doi.org/10.1200/go-26-00330},
note = {CC BY},
}
RIS
TY - JOUR
TI - Quantifying a Neglected Burden: Pregnancy-Associated Hepatocellular Carcinoma and Maternal Death in South Africa
AU - Keith Venter
AU - Sanju Sobnach
AU - Urda Kotze
AU - Inae Kim
AU - C. Wendy Spearman
AU - Mark Sonderup
AU - Neliswa Gogela
AU - Dale Creamer
AU - Ayesha Osman
AU - Leann Schoeman
AU - Marc Bernon
AU - Eduard Jonas
PY - 2026
DA - 2026/11/04
JO - JCO Global Oncology
DO - 10.1200/go-26-00330
UR - https://doi.org/10.1200/go-26-00330
AB - PurposeHepatocellular 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.MethodsPregnant 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.ResultsOf 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.ConclusionPregnancy-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.
SN - 2687-8941
ER -