Systematic review with meta-analysis: autoimmune hepatitis in pregnancy.

BACKGROUND

Maternal and fetal outcomes in pregnant patients with autoimmune hepatitis (AIH) has been largely unexplored.

AIM

This meta-analysis aims to determine the level of evidence associated with both maternal and fetal outcomes in patients with AIH.

METHODS

We conducted a comprehensive literature search. The studies included AIH patients who had at least one pregnancy with a previously known or index presentation diagnosis of AIH. We used a random-effects model using odds ratios (OR) with 95% confidence intervals (CI).

RESULTS

Fourteen studies with 1452 AIH patients and with a total of 1556 gestations were included. Analysis revealed statistically significant increased likelihood of diabetes mellitus in the AIH group (OR: 5.73, 95% CI: 2.73-12.02;  < .001,  = 2) compared to controls. Fetal outcomes that indicated a statistically significant association with AIH included premature birth (OR: 2.20, 95% CI:1.66-2.91;  < .001,  = 3), small for gestational age (SGA) births (OR: 2.48, 95% CI:1.37-4.51;  = .003,  = 2) and low birth weight (LBW) (OR: 3.04, 95% CI:1.85-5.01;  < .001,  = 1). AIH pregnancies were significantly less likely to have a full-term birth (OR: 0.32, 95% CI:0.21-0.49;  < .001,  = 2).

CONCLUSIONS

This meta-analysis provides the first pooled evidence that autoimmune hepatitis is associated with a substantial increase in maternal Pre-pregnancy and gestational diabetes mellitus, and that AIH females are more likely to have premature births, small for gestational age (SGA) births, and low birth weight (LBW) babies and a substantial decrease in full term birth compared to normal controls. This data is important for clinicians managing these patients before, during and after pregnancy.