Outcomes of Pregnancy in Autoimmune Hepatitis: A Population-Based Study.

BACKGROUND & AIMS Autoimmune hepatitis (AIH) disproportionately affects young women, which may have implications in pregnancy. However, data on pregnancy outcomes in women with AIH are limited. APPROACH & RESULTS Using weighted discharge data from the United States National Inpatient Sample from 2012-2016, we evaluated pregnancies after 20 weeks gestation and compared outcomes in AIH to other chronic liver diseases (CLD) or no CLD in pregnancy. The association of AIH with maternal and perinatal outcomes was assessed by logistic regression. Among 18,595,345 pregnancies, 935 (<0.001%) had AIH (60 with cirrhosis) and 120,100 (0.006%) had other CLD (845 with cirrhosis). Temporal trends in pregnancies with AIH remained stable from 2008-2016 with 1.4-6.8/100,000 pregnancies per year (p=0.25). On adjusted analysis, the odds of gestational diabetes (GDM) and hypertensive complications (pre-eclampsia, eclampsia, or hemolysis, elevated liver enzymes, low platelets) were significantly higher in AIH compared to other CLD (GDM: OR 2.2, 95% CI 1.5-3.9, p<0.001; hypertensive complications: OR 1.8, 95% CI 1.0-3.2, p=0.05) and also compared to no CLD in pregnancy (GDM: OR 2.4, 95% CI 1.6-3.6, p<0.001; hypertensive complications: OR 2.4, 95% CI 1.3-4.1, p=0.003). AIH was also associated with preterm births when compared to women without CLD (OR 2.0, 95% CI 1.2-3.5, p=0.01). AIH was not associated with postpartum hemorrhage, maternal, or perinatal death. CONCLUSIONS Rates of pregnancy in women with AIH have remained stable in recent years, though AIH is associated with notable maternal and perinatal risks, such as GDM, hypertensive complications, and preterm birth. Whether these risks are influenced by steroid use and/or AIH disease activity warrants evaluation. These data support a low risk of postpartum hemorrhage, and favorable survival of mothers and infants.