title: Good maternal and fetal outcomes for pregnant women with primary biliary cirrhosis.
abstract: OBJECTIVE
  Up to 25% of patients diagnosed with primary biliary cirrhosis (PBC) are of childbearing age. However, little is known about disease course during pregnancy.
  
  
  METHODS
  We performed a retrospective analysis of women with PBC during pregnancy using a representative large cohort of patients attending the Liver Center at Toronto Western hospital from January 1979 through June 2009 (n = 306). Statistical analysis was performed by using R statistical software.
  
  
  RESULTS
  We identified 32 women (50 pregnancies) who either became pregnant after a diagnosis of PBC or in whom pregnancy led to diagnosis. Liver biochemistry remained stable in most patients (70%) throughout pregnancy. However, 23 of 32 patients (72%) had a flare in biochemical disease activity post partum, which was unrelated to biochemical disease activity before conception (P = .53), or during the gestational period (P = .14). No adverse maternal events were observed during pregnancy or post partum, and only 2 of 32 of women (6%) developed progressive disease after delivery. De novo pruritus developed during pregnancy in 17 of 32 women (53%), whereas itch that existed before conception worsened for 4 patients. Fifteen of 21 women (71%) with pregnancy-related pruritus required symptom-specific therapy. Twenty-nine of 32 women (91%) had at least 1 successful live birth; adverse fetal outcome was not influenced by biochemical disease activity before conception (P = .24) or during pregnancy (P = 1.00).
  
  
  CONCLUSIONS
  Pregnancy in women with PBC is frequently symptomatic but mostly uneventful. The majority of women maintain stable liver biochemistry during pregnancy, although postpartum biochemical exacerbations are common.
authors: Liver Center, Toronto Western Hospital, Toronto, Ontario, Canada; National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit (BRU) and Centre for Liver Research, University of Birmingham, Birmingham, UK.
authors: Palak J
authors: PJ
authors: Trivedi
authors: Liver Center, Toronto Western Hospital, Toronto, Ontario, Canada; Gastroenterology and Metabology, Ehime University, Graduate School of Medicine, Shitsukawa To-on, Ehime, Japan.
authors: Teru
authors: T
authors: Kumagi
authors: Liver Center, Toronto Western Hospital, Toronto, Ontario, Canada; Royal Hospital, Muscat, Sultanate of Oman.
authors: Nadya
authors: N
authors: Al-Harthy
authors: Liver Center, Toronto Western Hospital, Toronto, Ontario, Canada.
authors: Catalina
authors: C
authors: Coltescu
authors: National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit (BRU) and Centre for Liver Research, University of Birmingham, Birmingham, UK.
authors: Stephen
authors: S
authors: Ward
authors: Liver Center, Toronto Western Hospital, Toronto, Ontario, Canada.
authors: Angela
authors: A
authors: Cheung
authors: Liver Center, Toronto Western Hospital, Toronto, Ontario, Canada; National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit (BRU) and Centre for Liver Research, University of Birmingham, Birmingham, UK. Electronic address: g.hirschfield@bham.ac.uk.
authors: Gideon M
authors: GM
authors: Hirschfield
mesh_terms: D000328:Adult; D002170:Canada; D005260:Female; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000473:pathology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000473:pathology*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D055815:Young Adult
keywords: Autoimmune Liver Disease; Cholestasis; Fetus; Neonatal; Pruritus; Ursodeoxycholic Acid