Good Maternal and Fetal Outcomes for Pregnant Women With聽Primary Biliary Cirrhosis

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• 作者：Palak J. Trivedi^&lowast ; ; ^&Dagger ; ; Teru Kumagi^&lowast ; ; ^§ ; ; Nadya Al-Harthy^&lowast ; ; ^鈥?/sup> ; Catalina Coltescu^&lowast ; ; Stephen Ward^&Dagger ; ; Angela Cheung^&lowast ; ; Gideon M. Hirschfield^&lowast ; ; ^&Dagger ; ; ^{g.hirschfield@bham.ac.uk" class="auth_mail}
• 关键词：Autoimmune Liver Disease ; Cholestasis ; Ursodeoxycholic Acid ; Fetus ; Neonatal ; Pruritus
• 刊名：Clinical Gastroenterology and Hepatology
• 出版年：July 2014
• 年：2014
• 卷：12
• 期：7
• 页码：1179-1185.e1
• 全文大小：885 K

文摘

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.