Pregnancy in Autoimmune Hepatitis: Outcome and Risk Factors

Schramm, Christoph; Herkel, Johannes; Beuers, Ulrich; Kanzler, Stephan; Galle, Peter R.; Lohse, Ansgar W.

doi:10.1111/j.1572-0241.2006.00479.x

Cited by 199 publications

(196 citation statements)

References 25 publications

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“…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 ). Treatment for AIH is based on immunosuppression with corticosteroids and/or AZA, with recent practice guidelines for AIH recommending prednisone monotherapy for pregnant individuals ( 126 ).…”

Section: Autoimmune Hepatitismentioning

confidence: 99%

ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

236

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%

ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

236

257

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“…AIH affects young women, and it is common to be faced with a patient with established AIH who either wants to become pregnant or has already done so. Most patients with AIH can expect a good outcome, whereas higher rates of maternal and fetal problems are reported particularly in patients with type 2 or 3 AIH [9]. Unexplained adverse pregnancy outcomes were associated with antibodies to SLA/LP and Ro/SSA in the affected mothers [9].…”

Section: Aih and Pregnancymentioning

confidence: 99%

“…Most patients with AIH can expect a good outcome, whereas higher rates of maternal and fetal problems are reported particularly in patients with type 2 or 3 AIH [9]. Unexplained adverse pregnancy outcomes were associated with antibodies to SLA/LP and Ro/SSA in the affected mothers [9]. In addition, the disease may flare after delivery, as the pregnancy-associated immunosuppressive state is lost [167,168].…”

Section: Aih and Pregnancymentioning

confidence: 99%

“…Physical examination may be normal or reveal hepatomegaly, splenomegaly, jaundice, and signs of chronic liver disease. AIH may first become evident during pregnancy or in the early postpartum period [7][8][9]. Furthermore, postpartum exacerbations may occur in patients whose condition improved during pregnancy as a consequence of the natural pregnancy-associated immunosuppressed state [10,11].…”

Section: Presentationmentioning

confidence: 99%

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Autoimmune hepatitis: new paradigms in the pathogenesis, diagnosis, and management

2010

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Autoimmune hepatitis (AIH), primary biliary cirrhosis, and primary sclerosing cholangitis are the three major autoimmune diseases affecting the liver, and of these three, AIH is the most typical autoimmune disease being characterized by a T-cell-rich infiltrate, raised circulating c-globulins, autoantibodies, HLA associations, and links with other autoimmune diseases. It is the only one, of the three diseases, that responds well to immunosuppressive therapy. AIH is caused by dysregulation of immunoregulatory networks and the consequent emergence of autoreactive T cells that orchestrate a progressive destruction of hepatocytes leading untreated to liver failure. T cells play a major role in the immunopathogenesis, and both CD4? and CD8? T cells are involved together with effector responses mediated by NK cells, cd T cells, and macrophages. A number of triggering factors have been proposed including viruses, xenobiotics, and drugs, but none have been conclusively shown to be involved in pathogenesis.

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“…Long periods of subclinical disease may also ensue after presentation. Recent surveys of pregnancy in AIH have indicated that the initial presentations of AIH may occur not only during pregnancy but in the early post-partum period [14,15] . AIH may occur in conjunction with a variety of autoimmune disorders, including celiac disease [16,17] .…”

Section: Clinical Featuresmentioning

confidence: 99%

Clinical features and management of autoimmune hepatitis

Krawitt¹

2008

WJG

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Autoimmune hepatitis (AIH) is a chronic hepatitis of unknown etiology which can progress to cirrhosis. Its clinical manifestations are highly variable and sometimes follow a fluctuating course. Diagnosis is based on characteristic histologic, clinical, biochemical and serological findings. Anti-inflammatory/immunosuppressive treatment frequently induces remission but long-term maintenance therapy is often required. Liver transplantation is generally successful in patients with decompensated cirrhosis unresponsive to or intolerant of medical therapy.

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Pregnancy in Autoimmune Hepatitis: Outcome and Risk Factors

Abstract: The presence of autoantibodies may be a risk factor for adverse pregnancy outcome in AIH patients. Close monitoring of both mother and fetus seems advisable due to a significant rate of maternal and fetal complications.

Cited by 199 publications

References 25 publications

ACG Clinical Guideline: Liver Disease and Pregnancy

ACG Clinical Guideline: Liver Disease and Pregnancy

Autoimmune hepatitis: new paradigms in the pathogenesis, diagnosis, and management

Clinical features and management of autoimmune hepatitis

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