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Clin Gastroenterol Hepatol. 2014 Jul;12(7):1179-1185.e1. doi: 10.1016/j.cgh.2013.11.030. Epub 2013 Dec 7.

Good maternal and fetal outcomes for pregnant women with primary biliary cirrhosis.

Author information

  • 1Liver Center, Toronto Western Hospital, Toronto, Ontario, Canada; National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit (BRU) and Centre for Liver Research, University of Birmingham, Birmingham, UK.
  • 2Liver Center, Toronto Western Hospital, Toronto, Ontario, Canada; Gastroenterology and Metabology, Ehime University, Graduate School of Medicine, Shitsukawa To-on, Ehime, Japan.
  • 3Liver Center, Toronto Western Hospital, Toronto, Ontario, Canada; Royal Hospital, Muscat, Sultanate of Oman.
  • 4Liver Center, Toronto Western Hospital, Toronto, Ontario, Canada.
  • 5National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit (BRU) and Centre for Liver Research, University of Birmingham, Birmingham, UK.
  • 6Liver Center, Toronto Western Hospital, Toronto, Ontario, Canada; National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit (BRU) and Centre for Liver Research, University of Birmingham, Birmingham, UK. Electronic address: g.hirschfield@bham.ac.uk.

Abstract

BACKGROUND & AIMS:

Up to 25% of patients diagnosed with primary biliary cirrhosis (PBC) are of childbearing age. However, little is known about disease course during pregnancy.

METHODS:

We performed a retrospective analysis of women with PBC during pregnancy using a representative large cohort of patients attending the Liver Center at Toronto Western hospital from January 1979 through June 2009 (n = 306). Statistical analysis was performed by using R statistical software.

RESULTS:

We identified 32 women (50 pregnancies) who either became pregnant after a diagnosis of PBC or in whom pregnancy led to diagnosis. Liver biochemistry remained stable in most patients (70%) throughout pregnancy. However, 23 of 32 patients (72%) had a flare in biochemical disease activity post partum, which was unrelated to biochemical disease activity before conception (P = .53), or during the gestational period (P = .14). No adverse maternal events were observed during pregnancy or post partum, and only 2 of 32 of women (6%) developed progressive disease after delivery. De novo pruritus developed during pregnancy in 17 of 32 women (53%), whereas itch that existed before conception worsened for 4 patients. Fifteen of 21 women (71%) with pregnancy-related pruritus required symptom-specific therapy. Twenty-nine of 32 women (91%) had at least 1 successful live birth; adverse fetal outcome was not influenced by biochemical disease activity before conception (P = .24) or during pregnancy (P = 1.00).

CONCLUSION:

Pregnancy in women with PBC is frequently symptomatic but mostly uneventful. The majority of women maintain stable liver biochemistry during pregnancy, although postpartum biochemical exacerbations are common.

Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Autoimmune Liver Disease; Cholestasis; Fetus; Neonatal; Pruritus; Ursodeoxycholic Acid

PMID:
24321209
[PubMed - in process]
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