Leiden University Scholarly Publications

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Fischer, S.E.; Vries, E.S. de; Tushuizen, M.E.; Boer, Y.S. de; Meer, A.J.P. van der; Man, R.A. de; ... ; Hoek, B. van (2023)

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

Article / Letter to editor
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 post-partum episodes. Absence of complete biochemical response at conception was identified as risk factor for the occurrence of gestational and post-partum relapses. Relapse of AIH in the year before...Show moreBackground 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 post-partum episodes. Absence of complete biochemical response at conception was identified as risk factor for the occurrence of gestational and post-partum relapses. Relapse of AIH in the year before conception was a risk factor for the occurrence of both gestational relapses and post-partum relapses. No complete biochemical response increased the risk for hypertensive disorders during pregnancy and intrahepatic cholestasis of pregnancy (ICP). Cirrhosis was found to be a risk factor for miscarriages, but not for other outcomes. Conclusion: Pregnancy in AIH is related to an increased incidence of maternal and fetal/neonatal complications; in most cases, outcome is good. Incomplete biochemical response at conception or relapse in the year before conception are risk factors for gestational and post-partum relapses, for hypertensive disorders and for ICP. Cirrhosis was a risk factor for miscarriages.Show less
autoimmune hepatitis
outcome
pregnancy
remission
All authors
Fischer, S.E.; Vries, E.S. de; Tushuizen, M.E.; Boer, Y.S. de; Meer, A.J.P. van der; Man, R.A. de; Brouwer, J.T.; Kuyvenhoven, J.P.; Klemt-Kropp, M.; Gevers, T.J.G.; Tjwa, E.T.T.L.; Kuiper, E.M.M.; Verhagen, M.A.M.T.; Friederich, P.W.; Hoek, B. van
Date
2023-01-13
Journal
Liver International
Volume
43
Issue
4
Pages
855 - 864
DOI
doi:10.1111/liv.15511