Patients with autoimmune hepatitis have higher risk for perinatal adverse outcomes

Patients with autoimmune hepatitis had higher rates of gestational diabetes and hypertensive complications compared with patients with other chronic liver diseases and higher odds for preterm birth compared with controls, per two speakers.

Researchers presented the abstracts at The Liver Meeting Digital Experience.

“Autoimmune hepatitis is a disease that disproportionately affects young women, which may have implications on reproductive health,” Connie W. Wang, MD, a gastroenterology fellow at University of California, San Francisco, said during her presentation. “However, data on pregnancy outcomes in women with autoimmune hepatitis are limited.

“It is unclear whether autoimmune hepatitis confers more serious material and fetal risks.”

To analyze the association of autoimmune hepatitis with perinatal outcomes, Wang and colleagues used data from the United States National Inpatient Sample gathered from 2012 to 2016 and compared pregnancy outcomes of 935 patients who had autoimmune hepatitis with 120,100 patients who had another chronic liver disease, including 845 who had cirrhosis. The study’s outcomes of interest included gestational diabetes and hypertension; hypertensive complications including pre-eclampsia, eclampsia or hemolysis elevated liver tests and low platelet syndrome; postpartum hemorrhage; mortality; preterm birth; and abnormal fetal growth.

Patients with autoimmune hepatitis more frequently had gestational diabetes (17.1% vs. .87%; P < .001) and hypertensive complications (8.6% vs. 4.4%, P = .005) compared with patients who had other chronic liver diseases. In an analysis adjusted for age, race, multiple gestation and comorbidities, the odds for gestational diabetes (OR = 2.2; 95% CI, 1.6-3.6) and hypertensive complications (OR = 1.8; 95% CI, 1.0-3.2) “were significantly higher” in patients with autoimmune hepatitis, researchers wrote. Wang and colleagues also found that patients with autoimmune hepatitis had increased odds for preterm births (OR = 2; 95% CI, 1.2-3.5) compared with other chronic liver diseases.

Their results echo the conclusions of Hydar El Jamaly of the department of gastroenterology and hepatology at Nepean Hospital in New South Whales, Australia, and colleagues. Jamaly and colleagues’ meta-analysis found an increased risk for diabetes among 641 patients who were pregnant and had autoimmune hepatitis (OR = 5.68; 95% CI, 2.71-11.92) compared with 578,252 total patients who were pregnant, as well as increased odds for premature births (OR = 2.73; 95% CI, 1.89-3.95). Further, they found a significant association between autoimmune hepatitis and infants who were small for gestational age (OR = 2.47; 95% CI, 1.36-4.5) and low birth weights (OR = 3.04; 95% CI, 1.85-5.01).

Jamaly and colleagues also found significant event rates of pregnancy complications among patients with autoimmune hepatitis, including pregnancy flare (event rate: 12%; 95% CI, 8-17), postpartum flare (event rate: 34%; 95% CI, 25-46), decompensated cirrhosis (event rate: 32%; 95% CI, 24-41), liver transplant during pregnancy (event rate: 8%; 95% CI, 5-14) and mortality related to autoimmune hepatitis (event rate: 3%; 95% CI, 2-6).

“This data is important for management of pregnant individuals before, during and after pregnancy,” Jamaly said during his presentation. “The take home message is autoimmune hepatitis and pregnancy is associated with substantial, adverse maternal and fetal outcomes.

“Pregnant individuals with autoimmune hepatitis should be educated immediately after diagnosis and closely monitored.”