Importance of complete response for outcomes of pregnancy in patients with autoimmune hepatitis

Fischer, Susan E.; Vries, Elsemieke S de; Tushuizen, Maarten E.; Boer, Ynto S. de; Meer, Adriaan J P van der; Man, Robert A. de; Brouwer, Johannes T.; Kuyvenhoven, J.; Klemt-Kropp, Michael; Gevers, Tom J.G.; Tjwa, Eric T.; Kuiper, Edith M. M.; Verhagen, M. A. M. T.; Friederich, Philip W.; Hoek, Bart van

doi:10.1111/liv.15511

Cited by 7 publications

(10 citation statements)

References 39 publications

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“…A retrospective study conducted in the Netherlands found that 6% of AIH patients experienced a relapse, while the relapse rate for postpartum episodes was 27%. However, pregnancies among AIH patients had a success rate of 98.5%, with 72% resulting in childbirth [ 8 ]. According to Schramn et al, approximately 20% of individuals with AIH experience a flare during pregnancy, with flares being more frequent during the postpartum period compared to during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…The underlying pathology of AIH involves a gradual inflammation of hepatocytes, which cannot be attributed to common causes of chronic liver disease such as alcohol-related liver disease, viral hepatitis, exposure to hepatotoxic substances, or hereditary liver disorders [2][3][4][5][6]. Various clinical studies have examined pregnancy outcomes in AIH patients [6][7][8][9][10][11]. Some studies suggest that flares of the disease are more common in the postpartum period compared to during pregnancy [6,8,9,11], while others report remission of the disease during pregnancy [9].…”

Section: Introductionmentioning

confidence: 99%

“…Various clinical studies have examined pregnancy outcomes in AIH patients [6][7][8][9][10][11]. Some studies suggest that flares of the disease are more common in the postpartum period compared to during pregnancy [6,8,9,11], while others report remission of the disease during pregnancy [9].…”

Section: Introductionmentioning

confidence: 99%

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Refractory Thrombocytopenia in a 29-Year-Old Pregnant Woman With Autoimmune Hepatitis: A Case Report and Literature Review

Al-Sum,

Alsurori,

Alkhlassi

et al. 2023

Cureus

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Autoimmune hepatitis (AIH) is a rare autoimmune liver disease that mostly affects women in their reproductive years, leading to impaired fertility. Nonetheless, the majority of women with well-controlled AIH have a favorable prognosis for pregnancy. This case report describes a 29-year-old pregnant woman with cirrhosis secondary to AIH who presented with severe thrombocytopenia. Her labs showed a decline in her platelet counts from 28 × 10 9 /L before pregnancy to 20 × 10 9 /L during pregnancy. Her abdominal ultrasound showed liver cirrhosis secondary to AIH and splenomegaly. Throughout pregnancy, various scans were performed to monitor the fetal well-being, which showed normal results. She was on a medication regimen that included nadolol of 80 mg/kg/day, prednisolone of 5 mg/kg/day, and azathioprine of 50 mg/kg/day. Due to a breech presentation, the patient was scheduled for a cesarean section. She received two courses of dexamethasone at 20 mg/day for four days within two weeks of delivery. On the day of her scheduled C-section, tranexamic acid of 1 g TID for two days was administered, and she received platelet transfusions of 12 units both before and after the procedure, with an additional 6 units administered during the procedure. Despite proper management, her platelet count remained consistently low. However, she successfully delivered a healthy baby, and the overall condition of the patient was stable.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Refractory Thrombocytopenia in a 29-Year-Old Pregnant Woman With Autoimmune Hepatitis: A Case Report and Literature Review

Al-Sum,

Alsurori,

Alkhlassi

et al. 2023

Cureus

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“…There are many aspects of JAIH that may affect pregnancy: presence or not of cirrhosis and related complications; presence of potentially dangerous comorbidities due to concomitant autoimmune diseases such as type 1 diabetes or antiphospholipid syndrome; biochemical remission or active disease at the beginning of pregnancy; ongoing immunosuppression regimen and its potential toxicity or teratogenicity for the fetus. The literature addressing this issue can be roughly divided into two categories: population-based cohort studies [78][79][80] and single-center retrospective reports [81][82][83][84][85]. In population-based studies data, are retrieved from health registries via the ICD code, in one case matched with histopathology report data [78].…”

Section: Jaih and Future Pregnanciesmentioning

confidence: 99%

Juvenile Autoimmune Hepatitis: Recent Advances in Diagnosis, Management and Long-Term Outcome

Nastasio,

Mosca,

Alterio

et al. 2023

Diagnostics

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Juvenile autoimmune hepatitis (JAIH) is severe immune-mediated necro-inflammatory disease of the liver with spontaneous progression to cirrhosis and liver failure if left untreated. The diagnosis is based on the combination of clinical, laboratory and histological findings. Prothrombin ratio is a useful prognostic factor to identify patients who will most likely require a liver transplant by adolescence or early adulthood. JAIH treatment consists of immune suppression and should be started promptly at diagnosis to halt inflammatory liver damage and ultimately prevent fibrosis and progression to end-stage liver disease. The risk of relapse is high especially in the setting of poor treatment compliance. Recent evidence however suggests that treatment discontinuation is possible after a prolonged period of normal aminotransferase activity without the need for liver biopsy prior to withdrawal.

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“…Pregnancy in the context of AIH is a critical issue, as it can lead to obstetric complications such as a pre-term birth, a miscarriage, and perinatal morbidity, especially if cirrhosis is present [ 29 , 30 , 31 , 32 ]. As for maternal outcomes, AIH activity usually decreases during pregnancy [ 32 , 33 , 34 ], so the immunosuppressive therapy should be titrated to the lowest effective dose, but flares can occur in 30% (13–55%) of the cases, especially in the postpartum period [ 31 , 32 , 35 , 36 ]. Prednisone and azathioprine are considered safe in pregnancy and represent the mainstay of AIH treatment in pregnant women; on the other hand, treatments such as mycophenolate mofetil and tacrolimus are contraindicated due to harmful effects on the fetus [ 8 , 28 ].…”

Section: Acute and Chronic Liver Diseases Not Specific To Pregnancymentioning

confidence: 99%

Diagnostic Approach to Elevated Liver Function Tests during Pregnancy: A Pragmatic Narrative Review

Dajti,

Bruni,

Barbara

et al. 2023

JPM

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Liver disease is not uncommon during pregnancy and is associated with increased maternal and fetal/neonatal morbidity and mortality. Physiological changes during pregnancy, including a hyperestrogenic state, increase in circulating plasma volume and/or reduction in splanchnic vascular resistance, and hemostatic imbalance, may mimic or worsen liver disease. For the clinician, it is important to distinguish among the first presentation or exacerbation of chronic liver disease, acute liver disease non-specific to pregnancy, and pregnancy-specific liver disease. This last group classically includes conditions such as hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, liver disorders associated with the pre-eclampsia spectrum, and an acute fatty liver of pregnancy. All of these disorders often share pathophysiological mechanisms, symptoms, and laboratory findings (such as elevated liver enzymes), but a prompt and correct diagnosis is fundamental to guide obstetric conduct, reduce morbidity and mortality, and inform upon the risk of recurrence or development of other chronic diseases later on in life. Finally, the cause of elevated liver enzymes during pregnancy is unclear in up to 30–40% of the cases, and yet, little is known on the causes and mechanisms underlying these alterations, or whether these findings are associated with worse maternal/fetal outcomes. In this narrative review, we aimed to summarize pragmatically the diagnostic work-up and the management of subjects with elevated liver enzymes during pregnancy.

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Importance of complete response for outcomes of pregnancy in patients with autoimmune hepatitis

Cited by 7 publications

References 39 publications

Refractory Thrombocytopenia in a 29-Year-Old Pregnant Woman With Autoimmune Hepatitis: A Case Report and Literature Review

Refractory Thrombocytopenia in a 29-Year-Old Pregnant Woman With Autoimmune Hepatitis: A Case Report and Literature Review

Juvenile Autoimmune Hepatitis: Recent Advances in Diagnosis, Management and Long-Term Outcome

Diagnostic Approach to Elevated Liver Function Tests during Pregnancy: A Pragmatic Narrative Review

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