Systematic review with meta-analysis: autoimmune hepatitis in pregnancy
Hydar El Jamaly, Guy D. Eslick, Martin Weltman
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% CI:1.66–2.91; p < .001, n = 3), small for gestational age (SGA) births (OR: 2.48, 95% CI:1.37–4.51; p = .003, n = 2) and low birth weight (LBW) (OR: 3.04, 95% CI:1.85–5.01; p < .001, n = 1). AIH pregnancies were significantly less likely to have a full-term birth (OR: 0.32, 95% CI:0.21–0.49; 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.