Outcomes of pregnancy in women with autoimmune hepatitis

Westbrook, Rachel; Yeoman, Andrew D.; Kriese, Stephen; Heneghan, Michael A.

doi:10.1016/j.jaut.2011.12.002

Cited by 145 publications

(192 citation statements)

References 24 publications

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“…AIH is associated with an increased risk of fetal prematurity and loss, with worse outcomes with inadequate AIH activity control, especially in the absence of or discontinuation of AIH treatment before or during pregnancy ( 123 ). Although AIH was historically thought to be quiescent during pregnancy, more recent data suggest that AIH may have an initial presentation during pregnancy, an intrapartum fl are risk of >20% and postpartum fl are risk of up to 30-50% ( 124,125 ).…”

Section: Autoimmune Hepatitismentioning

confidence: 99%

“…Concerns regarding AZA arose from animal studies using suprapharmacologic doses and nonoral delivery routes such as intraperitoneal or subcutaneous dosing, associated with limbic malformations, cleft palate, skeletal anomalies, and hematopoietic suppression. However, utilization of AZA during pregnancy for treatment of AIH has been reported to be safe in a limited number of case reports and series (128)(129)(130)(131)(132)(133)(134)(135)(136). AZA treatment in AIH during pregnancy has not been studied systematically.…”

Section: Autoimmune Hepatitismentioning

confidence: 99%

See 1 more Smart Citation

ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

242

257

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Consultation for liver disease in pregnant women is a common and oftentimes vexing clinical consultation for the gastroenterologist. The challenge lies in the need to consider the safety of both the expectant mother and the unborn fetus in the clinical management decisions. This practice guideline provides an evidence-based approach to common diagnostic and treatment challenges of liver disease in pregnant women. Am J Gastroenterol 2016; 111:176-194; doi: 10.1038/ajg.2015 Initial evaluation of pregnant patientA pregnant patient presenting with abnormal liver tests should undergo standard workup as with any non-pregnant individual (strong recommendation, very low level of evidence). Imaging in pregnancyUltrasound is safe and the preferred imaging modality used in assessment of abnormal liver tests suggestive of biliary tract disease (strong recommendation, low level of evidence).Magnetic resonance imaging without gadolinium can be used in the second and third trimester (conditional recommendation, low level of evidence).Computed tomography scans carry a risk of teratogenesis and childhood hematologic malignancies but may be used judiciously with minimized radiation protocols (2-5 rads; conditional recommendation, very low level of evidence). Endoscopy in pregnancyEndoscopy is safe in pregnancy but should be deferred until the second trimester if possible (strong recommendation, low level of evidence).Meperidine and propofol can be used for endoscopic sedation (strong recommendation, moderate level of evidence). Management of biliary disease in pregnancyERCP can be performed when indicated for pregnant women presenting with biliary disease that strongly necessitates intervention such as biliary pancreatitis, symptomatic choledocholithiasis, and/or cholangitis. Minimizing fetal exposure to fl uoroscopy is imperative (strong recommendation, low level of evidence).Symptomatic cholecystitis should be managed with early surgical intervention with laparoscopic cholecystectomy (strong recommendation, low level of evidence). Liver masses in pregnancyAsymptomatic hemangioma and focal nodular hyperplasia do not need routine imaging or surveillance during pregnancy (strong recommendation, very low level evidence).Hepatic adenomas should be monitored with ultrasound during pregnancy for growth. Patients with large adenomas (>5 cm) should be referred for resection prior to pregnancy (strong recommendation, low level of evidence). Hepatitis B in pregnancyActive-passive immunoprophylaxis with hepatitis B immunoglobulin and the HBV vaccination series should be administered to all infants born to HBV-infected mothers to prevent perinatal transmission (strong recommendation, low level of evidence).Women chronically infected with HBV and high viral load (>10 6 log copies/ml (200,000 IU/ml) and higher) should be offered antiviral medication with tenofovir or telbivudine in the third trimester to reduce perinatal transmission of HBV (strong recommendation, low level of evidence).C-section should not be performed electively in HBV-pos...

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Section: Autoimmune Hepatitismentioning

confidence: 99%

Section: Autoimmune Hepatitismentioning

confidence: 99%

ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

242

257

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“…13,14 In a recent study the overall maternal complication rate in patients with autoimmune hepatitis was ≈40%. 15 Women with cirrhosis had the highest risk of complications, including hepatitis flare and liver decompensation, but preeclampsia was not observed. 15 We wondered whether the preeclampsia in this patient was complicated by the hemolysis, elevated liver enzymes, low platelets syndrome.…”

Section: Discussionmentioning

confidence: 98%

“…15 Women with cirrhosis had the highest risk of complications, including hepatitis flare and liver decompensation, but preeclampsia was not observed. 15 We wondered whether the preeclampsia in this patient was complicated by the hemolysis, elevated liver enzymes, low platelets syndrome. Because of the hypersplenism, platelet count was already low before pregnancy and further declined during the course of pregnancy, whereas LD as a sign of hemolysis modestly increased, yet remaining below the proposed cutoff value of 600 U/L.…”

Section: Discussionmentioning

confidence: 98%

Differential Diagnosis of Preeclampsia

et al. 2012

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“…Although the diagnosis is occasionally made during pregnancy itself, usually, AIH activity decreases during pregnancy so that the intensity of immunosuppression can be reduced. After delivery, flares in disease activity may occur in up to 50 % of cases, so that close monitoring is warranted or alternatively, dose of immunosuppression should be increased [37,203]. Whereas most experts and the current European guideline recommend the continuation of azathioprine standard treatment during pregnancy, the AASLD guideline recommends stopping azathioprine since it is a FDA category D drug, with signals of teratogenicity in animal experiments.…”

Section: Clinical Relevancementioning

confidence: 99%

Immunology of hepatic diseases during pregnancy

2016

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The mother's immune system has to adapt to pregnancy accepting the semi-allograft fetus and preventing harmful effects to the developing child. Aberrations in feto-maternal immune adaptation may result in disease of the mother, such as liver injury. Five pregnancy-associated liver disorders have been described so far, however, little is known concerning immune alterations promoting the respective disease. These liver disorders are pre-eclampsia, hemolysis, elevated liver enzymes, low platelet count (HELLP), acute fatty liver, hyperemesis gravidarum, and intrahepatic cholestasis of pregnancy. On the other hand, pre-existing autoimmune liver injury of the mother can be affected by pregnancy. This review intends to summarize current knowledge linking feto-maternal immunology and liver inflammation with a special emphasis on novel potential biomarkers.

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Outcomes of pregnancy in women with autoimmune hepatitis

Cited by 145 publications

References 24 publications

ACG Clinical Guideline: Liver Disease and Pregnancy

ACG Clinical Guideline: Liver Disease and Pregnancy

Differential Diagnosis of Preeclampsia

Immunology of hepatic diseases during pregnancy

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