Systematic review with meta‐analysis: outcomes of pregnancy in patients with autoimmune hepatitis

Si, Tengfei; Huang, Zhenlin; Hegarty, Robert; Ma, Yuanfang; Heneghan, Michael A.

doi:10.1111/apt.16924

Cited by 12 publications

(17 citation statements)

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“…LBW and very low birth weight (VLBW) were noted in 14.1% and 4.2% in this study versus 4.8% and 0.9% in the general population 28 . The incidence of preterm birth was similar compared to 12%–22% reported in AIH, 14–17,24 with exception of 7% in a small study 29 . No risk factors were found for preterm birth and no association was found between the use of azathioprine and preterm birth.…”

Section: Discussionsupporting

confidence: 71%

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

Fischer

Vries

Tushuizen

et al. 2023

Liver International

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Background and Aims: While some articles describe outcome of pregnancy in autoimmune hepatitis (AIH), there are less data evaluating influence of AIH control on maternal and perinatal outcomes. This study analysed outcomes of pregnancy and related possible risk factors in AIH. Method:A retrospective multicentre cohort study on pregnancy in AIH was performed in 11 hospitals in the Netherlands. Maternal and neonatal outcomes were collected from records and completed by interview. Risk factors-including incomplete response, relapse and cirrhosis-for adverse outcomes were identified using logistic regression analysis.Results: Ninety-seven pregnancies in 50 women resulted in 70 deliveries (72%) with a live birth rate of 98.5%. AIH relapse occurred in 6% during pregnancy, and in 27% of How to cite this article: Fischer SE, de Vries ES, Tushuizen ME, et al. Importance of complete response for outcomes of pregnancy in patients with autoimmune hepatitis.

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Section: Discussionsupporting

confidence: 71%

“…10 The available evidence shows that overall the outcome of pregnancy in AIH is good, but it has been associated with an increased incidence of complications. [11][12][13][14][15][16][17] There are less data evaluating the influence of AIH control on maternal and perinatal outcomes.…”

Section: Introductionmentioning

confidence: 99%

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

Fischer

Vries

Tushuizen

et al. 2023

Liver International

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“…In general, pregnancy and childbirth seem to be safe for both mother and child. [64][65][66][67][68][69] If not properly controlled, however, autoimmune hepatitis can flare up during pregnancy, and this is associated with a high rate of fetal and maternal complications within the range of 10-20%. Pregnancy should be initiated when the disease is in stable and persistent remission, 4 and immunosuppression with azathioprine should be neither reduced nor suspended, as its teratogenic potential in animals is not observed in humans.…”

Section: Older and Pediatric Patientsmentioning

confidence: 99%

“…Many female patients with autoimmune hepatitis at childbearing age request information on pregnancy in relation to their hepatic condition. In general, pregnancy and childbirth seem to be safe for both mother and child 646566676869. If not properly controlled, however, autoimmune hepatitis can flare up during pregnancy, and this is associated with a high rate of fetal and maternal complications within the range of 10-20%.…”

Section: Special Patient Populations With Autoimmune Hepatitismentioning

confidence: 99%

Diagnosis and management of autoimmune hepatitis

Muratori

Lohse

Lenzi

2023

BMJ

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Autoimmune hepatitis is an inflammatory disease of the liver of unknown cause that may progress to liver cirrhosis and end stage liver failure if diagnosis is overlooked and treatment delayed. The clinical presentation is often that of acute hepatitis, sometimes very severe; less frequently, it can be insidious or completely asymptomatic. The disease can affect people of any age and is more common in women; its incidence and prevalence seem to be on the rise worldwide. An abnormal immune response targeting liver autoantigens and inducing persistent and self-perpetuating liver inflammation is the pathogenic mechanism of the disease. A specific set of autoantibodies, increased IgG concentrations, and histological demonstration of interface hepatitis and periportal necrosis are the diagnostic hallmarks of autoimmune hepatitis. Prompt response to treatment with corticosteroids and other immunomodulatory drugs is almost universal and supports the diagnosis. The aims of treatment are to induce and maintain long term remission of liver inflammation. Treatment can often even reverse liver fibrosis, thus preventing progression to advanced cirrhosis and its complications. Most patients need lifelong maintenance therapy, and repeated follow-up in experienced hands improves the quality of care and quality of life for affected patients.

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“…The same meta-analysis demonstrated lower DA and risk of biochemical flare intrapartum compared to postpartum (relative risk, 0.31; p < 0.00001) except in those with portal hypertension who had increased risk of intrapartum loss of biochemical remission (LOBR). [5] Interestingly, stable disease at conception was associated with fewer postpartum LOBR and PTB. Preconception counseling would be the ideal opportunity to optimize DA before conception and manage patients with high risk with significant portal hypertension.…”

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confidence: 99%

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Chung

Heneghan

2022

Hepatology

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The authors referenced the Pregnancy Inflammatory bowel disease And Neonatal Outcomes registry data that demonstrated adverse pregnancy outcomes with corticosteroid exposure in patients with inflammatory bowel disease (IBD). [2] Corticosteroid use in IBD is associated with disease activity (DA), and doses are typically higher than maintenance dose used with autoimmune hepatitis (AIH). In the IBD cohort, it is difficult to differentiate the impact of DA versus corticosteroid use on pregnancy related outcomes. Data from systemic lupus erythematosus (SLE) pregnancies show the mean dose of corticosteroids greater than 6.5 and 10 mg per day is associated with an adverse outcome and preterm birth (PTB) respectively. [3] However, these adverse outcomes in SLE pregnancies were also associated with increased DA. This highlights the importance of maintaining inflammatory conditions in remission at conception and avoid flares necessitating the use of high dose corticosteroids during pregnancy.Data from the Danish and Swedish registry study of pregnancy outcomes in rheumatoid arthritis (RA) suggest that the DA may be the most significant risk factor for PTB and small for gestational age (SGA) compared with immunosuppression use including corticosteroids. [4] When 1739 pregnancies with RA were compared with 17,390 age-matched population controls, RA pregnancies with high DA had increased risk for PTB and even more so for SGA. Corticosteroid use in RA pregnancies showed significantly increased risk of PTB (adjusted odds ratio [aOR], 2.62; 95% confidence interval [CI], 1.23-5.59). However, when adjusted for DA, the risk was not statistically significant (aOR, 2.11; 95% CI, 0.94-4.74). The outcome associated with corticosteroid use may be a reflection of severe DA.A recent meta-analysis of AIH pregnancy outcomes showed no significant difference in fetal loss or PTB between patients receiving corticosteroid monotherapy and patients receiving corticosteroids with azathioprine. [5] This supports the use of azathioprine in AIH pregnancy in addition to more expansive data from IBD and rheumatology cohorts.

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Systematic review with meta‐analysis: outcomes of pregnancy in patients with autoimmune hepatitis

Abstract: Background: Autoimmune hepatitis (AIH) is common in females of childbearing age.Although some studies have provided information about the outcomes of pregnancy, there remains uncertainty regarding conclusions.

Cited by 12 publications

References 65 publications

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

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

Diagnosis and management of autoimmune hepatitis

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