Successful pregnancy with autoimmune cirrhosis

Abstract

Pregnancy with liver cirrhosis is a rare and dangerous event that exposes mother and fetus to potentially lethal risks. During pregnancy, hepatic decompensation could suffice and the development of hepatic failure and encephalopathy could occur. The incidence of obstetric complications is also increased with a high rate of pre-eclampsia, postpartum bleeding, preterm delivery and stillbirth. We report a case of a 27-year-old woman with autoimmune hepatitis and liver cirrhosis complicated by splenomegaly, oesophageal varices and severe thrombocytopaenia. During pregnancy, close clinical and analytical surveillance was performed. She was medicated with corticosteroids, azathioprine and propranolol. At the 25th week of gestation, an upper gastrointestinal endoscopy was performed to control oesophageal varices. This patient had an uneventful pregnancy until 37 weeks. At 37th week of gestation, after spontaneous rupture of membranes, signs of acute fetal distress were observed, and an urgent caesarean was performed. Good neonatal and maternal outcomes were achieved.

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

“…Seven studies addressed the disease activity change during pregnancy and mortality information, four addressed the comparison of pregnancy outcomes between different drug therapies, three population‐based cohort studies addressed the comparison of complications after delivery between AIH and matched non‐AIH populations. IPD from 26 case reports/series was extracted for systematic review 28–53 while no RCT was found. Five national cohort studies 25–27,54,55 were screened during literature searching and all of them were population‐based (AIH vs non‐AIH) among which, three were from Sweden 26,54,55 .…”

“…For the systematic review, a total of 16 case reports, 10 case series (sample sizes ranging from 2 to 7) published between 1960 and 2018 were screened 28–53 . IPD from each study was collected using a pre‐designed form.…”

Type 2 Autoimmune Hepatitis and Nonadherence to Medication Correlate With Premature Birth and Risk of Postpartum Flare

“…With the improvement of multidisciplinary care among hepatologists, obstetricians, and clinical nurse specialists in AIH, pregnancy is becoming increasingly common in patients with this rare disease. (5,7) Using an interrupted time-series approach, we have shown that during pregnancies in women with AIH, ALT and IgG decline significantly with gestation, followed by a significant step-change increase immediately after delivery. Remission of AIH during pregnancy is well documented, having been reported in several previous studies.…”

“…(4) AIH can affect any age group, including women of childbearing age. (2,5) Oligomenorrhea is common in patients with active disease or established cirrhosis. Nonetheless, many women with well-controlled disease can conceive and undergo pregnancies without complications.…”

Editorial: severe outcomes are rare in pregnancy in autoimmune hepatitis—Authors' reply

“…Similar data were not available for the children born to the general population controls. Previous studies reported a prevalence of congenital malformations at birth in children born to women with autoimmune hepatitis of 0%‐6% . Other studies with follow‐up data reported that malformations after birth were still uncommon: Schramm et al followed 35 children born to women with autoimmune hepatitis for a median of 5 years and found one child (3%) registered with a malformation; Westbrook et al followed 59 children born to women with autoimmune hepatitis for a median of 7 years and found no malformations; and finally, Danielsson et al reported responses to questionnaires regarding 99 previous pregnancies and the health of children after pregnancy in women with autoimmune hepatitis and found three children (3%) with malformations (two discovered at birth and one discovered after birth) …”