Pregnancy with Autoimmune Hepatitis
Gastroenterology and Hepatology from Bed to Bench,
Vol. 9 No. 3 (2016),
20 Khordad 2016
,
Page 220-224
https://doi.org/10.22037/ghfbb.v0i0.831
Abstract
Aim: The aim of this study was to review our experience with gestations in autoimmune hepatitis patients.
Background: There are only limited data describing pregnancy in patients with autoimmune hepatitis.
Patients and methods: Retrospective analysis of pregnancies with autoimmune hepatitis followed in Centro Hospitalar do Porto, Portugal in the last ten years.
Results: We reported nine pregnancies in seven patients with autoimmune hepatitis. Two patients had documented liver cirrhosis prior to the pregnancy. In this study, 66.7% of patients were treated with azathioprine and 88.9% with prednisolone. Clinical improvements were observed in 11.1% of pregnancies and 22.2% exacerbations were diagnosed. There were six live births and two preterm deliveries (preterm delivery rate of 33%). We also report three first trimester miscarriages (early gestation miscarriage rate of 33%). There were no neonatal or maternal deaths.
Conclusion: The favorable obstetric outcome is a realistic expectation in patients with autoimmune hepatitis. Tight monitoring and control of asymptomatic and unpredictable exacerbations, which are unrelated to the severity of the underlying disease, are essential to the prognosis of the current pregnancy.
- high-risk pregnancy
- liver disorder and pregnancy
- azathioprine
How to Cite
References
Waldenstrom J. [Liver, blood proteins and nutritive protein]. Deutsche Zeitschrift fur Verdauungs- und Stoffwechselkrankheiten. 1953;9:113-9.
Czaja AJ. Diagnosis and therapy of autoimmune liver disease. The Medical clinics of North America. 1996;80(5):973-94.
Krawitt EL. Autoimmune hepatitis. The New England journal of medicine. 2006;354(1):54-66.
Hennes EM, Zeniya M, Czaja AJ, Pares A, Dalekos GN, Krawitt EL, et al. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology. 2008;48(1):169-76.
McFarlane IG. Autoimmune hepatitis: diagnostic criteria, subclassifications, and clinical features. Clinics in liver disease. 2002;6(3):605-21.
Thiele DL. Autoimmune hepatitis. Clinics in liver disease. 2005;9(4):635-46, vi.
Terrabuio DR, Abrantes-Lemos CP, Carrilho FJ, Cancado EL. Follow-up of pregnant women with autoimmune hepatitis: the disease behavior along with maternal and fetal outcomes. Journal of clinical gastroenterology. 2009;43(4):350-6.
Buchel E, Van Steenbergen W, Nevens F, Fevery J. Improvement of autoimmune hepatitis during pregnancy followed by flare-up after delivery. The American journal of gastroenterology. 2002;97(12):3160-5.
Schramm C, Herkel J, Beuers U, Kanzler S, Galle PR, Lohse AW. Pregnancy in autoimmune hepatitis: outcome and risk factors. The American journal of gastroenterology. 2006;101(3):556-60.
Westbrook RH, Yeoman AD, Kriese S, Heneghan MA. Outcomes of pregnancy in women with autoimmune hepatitis. Journal of autoimmunity. 2012;38(2-3):J239-44.
Heneghan MA, Norris SM, O'Grady JG, Harrison PM, McFarlane IG. Management and outcome of pregnancy in autoimmune hepatitis. Gut. 2001;48(1):97-102.
Samuel D, Riordan S, Strasser S, Kurtovic J, Singh-Grewel I, Koorey D. Severe autoimmune hepatitis first presenting in the early post partum period. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2004;2(7):622-4.
Muratori P, Loffreda S, Muratori L, Ferrari R, Afandi K, Cassani F, et al. Spontaneous remission of autoimmune hepatitis during pregnancy. Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. 2002;34(8):608-9.
Lopez-Mendez E, Avila-Escobedo L. Pregnancy and portal hypertension a pathology view of physiologic changes. Annals of hepatology. 2006;5(3):219-23.
Alvarez F, Berg PA, Bianchi FB, Bianchi L, Burroughs AK, Cancado EL, et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. Journal of hepatology. 1999;31(5):929-38.
European Association for the Study of the Liver. Electronic address eee. EASL Clinical Practice Guidelines: Autoimmune hepatitis. Journal of hepatology. 2015;63(4):971-1004.
Valente AI, Almeida A, Gouveia A, Serejo F, Ramalho F, Baptista A, et al. [Prevalence of chronic hepatic disease in Portugal. Apropos of a review carried out in a hepatology unit]. Acta medica portuguesa. 1996;9(7-9):197-202.
Candia L, Marquez J, Espinoza LR. Autoimmune hepatitis and pregnancy: a rheumatologist's dilemma. Seminars in arthritis and rheumatism. 2005;35(1):49-56.
Tanaka H, Umekawa T, Kikukawa T, Toyoda N. Autoimmune hepatitis complicated with antiphospholipid syndrome in pregnancy. American journal of reproductive immunology. 2002;47(3):142-5.
Werner M, Bjornsson E, Prytz H, Lindgren S, Almer S, Broome U, et al. Autoimmune hepatitis among fertile women: strategies during pregnancy and breastfeeding? Scandinavian journal of gastroenterology. 2007;42(8):986-91.
Mottet C, Juillerat P, Pittet V, Gonvers JJ, Froehlich F, Vader JP, et al. Pregnancy and breastfeeding in patients with Crohn's disease. Digestion. 2007;76(2):149-60.
Petri M. Immunosuppressive drug use in pregnancy. Autoimmunity. 2003;36(1):51-6.
de Boer NK, Jarbandhan SV, de Graaf P, Mulder CJ, van Elburg RM, van Bodegraven AA. Azathioprine use during pregnancy: unexpected intrauterine exposure to metabolites. The American journal of gastroenterology. 2006;101(6):1390-2.
Ostensen M, Forger F. How safe are anti-rheumatic drugs during pregnancy? Current opinion in pharmacology. 2013;13(3):470-5.
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