title: Pregnancy in women with primary biliary cirrhosis.
abstract: OBJECTIVE
  Primary biliary cirrhosis (PBC) may present in all decades of life, also in childbearing age. Data on maternal and fetal outcome is limited. We aimed to investigate the impact of pregnancy and childbirth on the disease course and possible effects of PBC on fetal outcome.
  
  
  METHODS
  Retrospective study of local cases and a compact review of published reports between 1950 and 2014.
  
  
  RESULTS
  Our cases along with literature review provided 98 pregnancies in 72 PBC patients. PBC was diagnosed during pregnancy in 26 (36%) patients and 46 (64%) had the diagnosis before conception. Twenty-four (30%) of the pregnancies were associated with biochemical flares and 55 (70%) with clinical improvement or stabilization. De novo onset or worsening of pruritus was seen in 49% (45/92). No maternal deaths were reported. Post-partum disease activation was observed in 60% (53/88). One patient was referred for liver transplantation after delivery. A miscarriage rate of 24% and three stillbirths were reported. Most patients were treated with ursodeoxycholic acid (UDCA) during breastfeeding and 12 patients also received UDCA during the first trimester without any identified side effects.
  
  
  CONCLUSIONS
  Most women with PBC maintain a stable disease during pregnancy, but post-partum biochemical flares are common. Symptomatic pruritus may be challenging in pregnant PBC patients. UDCA appears to be safe during pregnancy and breastfeeding. A successful pregnancy outcome is a realistic expectation for women with PBC.
authors.affiliation: Department of Gastroenterology, Hacettepe University, Ankara, Turkey. Electronic address: drcumi21@hotmail.com.
authors.forename: Cumali
authors.initials: C
authors.lastname: Efe
authors.affiliation: Department of Gastroenterology, Hacettepe University, Ankara, Turkey.
authors.forename: Evrim
authors.initials: E
authors.lastname: Kahramanoğlu-Aksoy
authors.affiliation: Department of Gastroenterology, Hacettepe University, Ankara, Turkey.
authors.forename: Bülent
authors.initials: B
authors.lastname: Yilmaz
authors.affiliation: Department of Gastroenterology, Hacettepe University, Ankara, Turkey.
authors.forename: Burak
authors.initials: B
authors.lastname: Ozseker
authors.affiliation: Department of Neonatology, Gaziosmanpaşa University, Tokat, Turkey.
authors.forename: Sahin
authors.initials: S
authors.lastname: Takci
authors.affiliation: Department of Gastroenterology, Hacettepe University, Ankara, Turkey.
authors.forename: Emir Charles
authors.initials: EC
authors.lastname: Roach
authors.affiliation: Department of Gastroenterology, Hacettepe University, Ankara, Turkey.
authors.forename: Tugrul
authors.initials: T
authors.lastname: Purnak
authors.affiliation: Department of Gastroenterology, Hacettepe University, Ankara, Turkey.
authors.forename: Taylan
authors.initials: T
authors.lastname: Kav
authors.affiliation: Department of Gastroenterology, Numune Research and Education Hospital, Ankara, Turkey.
authors.forename: Ersan
authors.initials: E
authors.lastname: Ozaslan
authors.affiliation: Department of Gastroenterology and Hepatology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Staffan
authors.initials: S
authors.lastname: Wahlin
mesh_terms: D005260:Female; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000276:immunology* / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology* / Q000628:therapy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
chemical_list: D014580:Ursodeoxycholic Acid
keywords: Autoimmunity; Pregnancy; Primary biliary cirrhosis; Ursodeoxycholic acid