Pregnancy and primary biliary cirrhosis: A case–control study

Although very old papers reported a supposed alterations in sexual hormones, there are no specific reports on pregnancy in PBC. Aim: To analyze fertility in PBC and to investigate the outcome of pregnancy and the influence of pregnancy on the disease course. Methods: 233 consecutive female patients with PBC were included in the study (mean age at diagnosis of 52.9±12 years). Among them, 186 had at least one conception and were matched with a 1:2 group of 367 healthywomenwith at least one conception in their life. Results: There were 507 pregnancies in PBC patients and 700 in controls (mean average 1.91 vs. 2.73, p < 0.05). The life history in terms of miscarriages, voluntary interruption of pregnancy, term and preterm delivery was similar in the two groups. The number of caesarean deliveries was lower in PBC patients than in controls (8.6% vs. 15.5%, p < 0.05). Perinatal and postnatal death and child birth complications were observed only in the PBC patients (total number of babies = 11 [2.7%]). Pruritus during pregnancy was recorded in 13 patients with PBC (3.0% of total pregnancies) and in none of the control subjects. The risk of pruritus in PBC was associated to the advanced disease (stage III–IV: OR 78, 95% CI 5.55–1108.61, p < 0.05). The risk of miscarriage, corrected for age at pregnancy and number of previous miscarriages, was inversely associated with the histological stage (I–II: OR 0.32, 95% CI 0.10–0.97, p < 0.05). Eight pregnancies occurred after the diagnosis of PBC in 6 patients (two of them with histological stage IV). All pregnancies had a favorable course at term; ursodeoxycholic acid was continued and no worsening of the disease was observed. Conclusions: Successful completion of pregnancy is a realistic expectation for PBC patients; monitoring of pregnancy and delivery, however, is required due a potential risk of child birth complications.