PARIS -- Risk of adverse birth outcomes was greater in pregnant women with autoimmune hepatitis, but without an association with immunosuppression, a population-based study showed here.
Compared with matched controls, pregnant women with autoimmune hepatitis had increased risks of preterm birth and small-for-gestational age infants, reported Lisbeth Grønbæk, MD, of Aarhus University Hospital in Denmark, in a presentation at the International Liver Congress, the annual meeting of the European Association for the Study of the Liver (EASL).
Women with autoimmune hepatitis often have concerns about pregnancy and birth outcomes, but existing knowledge has been limited to small studies with no comparison group, the authors said. They examined data from Danish healthcare registries, comparing all 1,947 Danish women diagnosed with autoimmune hepatitis from 1994-2015 with 19,470 sex and age-matched population controls.
Among the women with autoimmune hepatitis, there were 28 miscarriages, 176 live births and no stillbirths. Rates of miscarriage were similar to controls, the authors noted (13.7% versus 11.8%, RR 1.2, 95% CI 0.8-1.7). There were 70 first-time births among women with autoimmune hepatitis.
There was no difference in fertility, with a similar first-time birth rate observed between the two groups. At the time of their first birth, both groups of women were similar in age, smoking habits, preeclampsia and caesarean section, although the authors found that women with autoimmune hepatitis were more likely to have pre-pregnancy diabetes and pregnancy-related pruritus.
A greater portion of women with autoimmune hepatitis had a preterm birth (<37 weeks of pregnancy) in their first birth compared to controls (17.1% versus 6.1%, respectively), and there was an increased risk of preterm birth after adjusting for maternal age and smoking habits (adjusted OR 3.2, 95% CI 1.5-6.6).
Compared with controls, there was also a greater portion of small-for-gestational age infants born to women with autoimmune hepatitis (0.6% versus 2.9%) but with a wide confidence interval due to lack of statistical power (adjusted OR 3.2, 95% CI 0.3-31.3). Two children with adverse birth outcomes died postpartum, and two were hospitalized postpartum.
There were 36 women with autoimmune hepatitis and a first-time birth on immunosuppression during pregnancy. Of note, the authors found no clear association between immunosuppression and adverse birth outcomes.
The American Association for the Study of Liver Diseases (AASLD) guidelines say that termination of immunosuppressive therapy during pregnancy should be attempted when possible, Grønbæk noted, "even though other studies have shown there are probably no side effects in terms of adverse birth outcomes and azathioprine." By contrast, EASL guidelines say that continuation of immunosuppressive therapy during pregnancy is justified.
"All these patients receiving immunosuppression received azathioprine and steroids, so in my opinion, patients should definitely continue with these during pregnancy," Grønbæk told MedPage Today. "We know from other studies that there's a risk of flare-ups after giving birth."
Seven women with autoimmune hepatitis were hospitalized post-partum, five of whom were off immunosuppression.
The authors also found no clear association between cirrhosis and adverse birth outcomes, although they noted that 27 out of 61 women with a previous liver biopsy had cirrhosis.
Grønbæk noted that they looked at the children born preterm or with other adverse birth outcomes (6 months after birth if they were hospitalized), and while these children were hospitalized more than the background population, it was mostly because of congenital malformations, which would be expected.
Beyond this registry-based data, Grønbæk said she would like to eventually establish a clinical database to get much more information on this specific group of patients.
"It's so difficult when you're in the outpatient clinics with these patients and asking all kinds of questions in terms of pregnancy and birth outcomes, so we need more clinical data," Grønbæk said.
This study was supported by the Danish Foundation of 17.12.1981, Torben and Alice Frimod's Danish Foundation and Aase and Enjar Danielsen's Danish Foundation.
The authors disclosed no conflicts of interest.
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