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

ABSTRACT

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; p < .001, n = 2) compared to controls. Fetal outcomes that indicated a statistically significant association with AIH included premature birth (OR 2.20, 95% CI1.66-2.91; p < .001, n = 3), small for gestational age (SGA) births (OR 2.48, 95% CI1.37-4.51; p = .003, n = 2) and low birth weight (LBW) (OR 3.04, 95% CI1.85-5.01; p < .001, n = 1). AIH pregnancies were significantly less likely to have a full-term birth (OR 0.32, 95% CI0.21-0.49; p < .001, n = 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.