Autoimmune Hepatitis Linked to Complications in Pregnant Women

No clinically meaningful disease worsening among women with well-controlled RA, juvenile arthritis.
In their presentation at The Liver Meeting, a team of investigators from the University of California, San Francisco sought to assess pregnancy outcomes in women with autoimmune hepatitis.

Autoimmune hepatitis (AIH) in pregnant women was found to be associated with an increased risk of gestational diabetes, hypertensive complications, and preterm birth, according to research presented at the Liver Meeting Digital Experience, November 13-16, 2020, hosted by the American Association for the Study of Liver Diseases.

Investigators used weighted discharge data from the US National Inpatient Sample from 2012 to 2016 to assess pregnancies after 20 weeks’ gestation and compared AIH outcomes with those of other chronic liver diseases or no chronic liver disease during pregnancy. They used logistic regression to assess the association of AIH with maternal and perinatal outcomes, including gestational diabetes, gestational hypertension, hypertensive complications (pre-eclampsia, eclampsia, or HELLP [hemolysis, elevated liver tests, and low platelet] syndrome), postpartum hemorrhage, preterm birth, abnormal fetal growth, and mortality.

From a total of 18,595,345 pregnancies, 935 (<0.001%) involved AIH (60 [6.4%] with cirrhosis), and 120,100 (0.006%) involved other chronic liver diseases (845 [0.7%] with cirrhosis). The temporal trend in pregnancies with AIH was reported to be stable from 2008 to 2016, with a rate of 1.4 to 6.8/100,000 pregnancies per year (P = .25). Compared with pregnancies with other chronic liver diseases, pregnancies with AIH had more gestational diabetes (17.1% vs 8.7%, P < .001) and hypertensive complications (8.6% vs 4.4%, P = .005). Higher rates of preterm birth were also seen in pregnancies with AIH vs those without chronic liver diseases (8.6% vs 4.6%, P = .01). Other outcomes were similar across the groups.

Adjusted analysis showed that the odds of gestational diabetes and hypertensive complications were significantly higher among AIH pregnancies compared with other chronic liver disease pregnancies (gestational diabetes: OR 2.2, 95% CI, 1.5-3.9, P < .001; hypertensive complications: OR 1.8, 95% CI, 1.0-3.2, P = .05) and pregnancies with no chronic liver disease (gestational diabetes: OR 2.4, 95% CI, 1.6-3.6, P < .001; hypertensive complications: OR 2.4, 95% CI, 1.3-4.1, P = .003). Pregnancies with AIH were also associated with higher odds of preterm birth compared with pregnancies with other chronic liver diseases (OR 2.0, 95% CI, 1.2-3.5, P = .01).

“Rates of AIH in pregnancy have remained stable in recent years,” the study authors commented. “AIH is associated with an increased risk of gestational diabetes, hypertensive complications, and preterm birth. Whether these risks are influenced by steroid use and/or AIH disease activity warrants evaluation. These data do support a low risk of postpartum hemorrhage and favorable survival of mothers and infants.”

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Wang C, Grab JD, Tana MM, Irani R, Sarkar M. Outcomes of pregnancy in autoimmune hepatitis: a population-based study. Poster presented at: The Liver Meeting Digital Experience; November 13-16, 2020. P0099.