Pregnancy outcomes in women with primary biliary cholangitis and primary sclerosing cholangitis: a retrospective cohort study

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 10 specialist centres managing pregnant women with liver disease Population Women with a diagnosis of PBC and PSC and a pregnancy of =20 completed weeks’ 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 with PBC were analysed. There were 60 livebirths and one intrapartum stillbirth that did not occur in the context of maternal cholestasis. Overall median gestation of delivery was 38 weeks, but the rate of preterm birth was 28% (17/61 deliveries) of which 76% (13/17) 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. Conclusion 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.