Pregnancy outcomes in women with primary biliary cholangitis and primary sclerosing cholangitis: a retrospective cohort study
| Autor: | Fionnuala M. McAuliffe, Sheba Khan, Tracey A. Johnston, Michael A Henehghan, Leonie Penna, Sheba Jarvis, Belinda Smith, Sumita Verma, Lucy Mackillop, Catherine Hedley, Rachel H. Westbrook, Fiona L. Mackie, Philip J. Steer, Matthew Cauldwell, Catherine Williamson, Jelle H Baalman, Janet E. Brennand, Samuel Dockree, Palak J Trivedi, Sarah Winifield |
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| Rok vydání: | 2020 |
| Předmět: |
Gestational hypertension
Adult medicine.medical_specialty Population Cholangitis Sclerosing digestive system Risk Assessment Primary sclerosing cholangitis 03 medical and health sciences 0302 clinical medicine Cholestasis Liver Function Tests Pregnancy medicine Humans education Retrospective Studies education.field_of_study 030219 obstetrics & reproductive medicine Obstetrics business.industry Liver Cirrhosis Biliary Infant Newborn Pregnancy Outcome Obstetrics and Gynecology Retrospective cohort study Jaundice medicine.disease digestive system diseases United Kingdom Pregnancy Complications Gestation Premature Birth Female medicine.symptom business |
| Zdroj: | BJOG : an international journal of obstetrics and gynaecologyReferences. 127(7) |
| ISSN: | 1471-0528 |
| Popis: | Objective To determine maternal, obstetric and neonatal outcomes in a cohort of women with primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC). Design Retrospective cohort study. Setting Ten specialist centres managing pregnant women with liver disease. Population Women with a diagnosis of PBC and PSC and a pregnancy of ≥20 completed weeks of gestation. Methods Retrospective case notes review. Main outcome measures Adverse outcomes were defined as: maternal - development of ascites, variceal bleeding, encephalopathy and jaundice; obstetric events - gestational hypertension, pre-eclampsia and postpartum haemorrhage; and neonatal - stillbirth, preterm delivery and admission to neonatal unit. The relationship of alanine transferase (ALT) and bile acid levels with gestation at delivery was studied. Results The first recorded pregnancies of 34 women with PSC and 27 women with PBC were analysed. There were 60 live births and one intrapartum stillbirth that did not occur in the context of maternal cholestasis. The overall median gestation of delivery was 38 weeks but the rate of preterm birth was 28% (17/61 deliveries), 76% (13/17) of which were spontaneous. Gestation at birth negatively correlated with maternal serum ALT concentration at booking (P = 0.017) and serum bile acid concentration during pregnancy (P = 0.016). There were no other significant correlations and maternal and neonatal outcomes were good. Conclusions Pregnancy in PBC and PSC is well tolerated, but women should be counselled regarding the increased risk of preterm birth. Measurement of maternal ALT and bile acids may help identify women at risk of preterm delivery. Tweetable abstract Pregnancy in women with PBC and PSC is well tolerated; however, rates of preterm birth are high and are related to maternal bile acid levels. |
| Databáze: | OpenAIRE |
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