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Hépato-Gastro & Oncologie Digestive

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Autoimmune liver diseases and pregnancy Volume 27, issue 5, Mai 2020

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Authors
CHU de Nantes, Hôtel Dieu, Institut des Maladies de l’Appareil Digestif (IMAD), Service d’hépato-gastroentérologie et oncologie médicale, 1 place Alexis Ricordeau, 44093 Nantes cedex 01
* Correspondance

Physiological changes in immunity during pregnancy may affect the course of autoimmune liver disease. An ongoing progressive chronic liver disease may have an impact on the course of pregnancy and therefore on the development and growth of the fetus. The main risk during autoimmune hepatitis is a flare-up during pregnancy, especially in the months after delivery. The risk is higher if the immunosuppressive treatment has been reduced or suspended during pregnancy: It should therefore be continued. The risk of prematurity is higher. During pregnancy in a woman with primary biliary cholangitis, stabilization or improvement in liver tests is most often seen. After delivery, worsening liver tests can occur in 70% of cases. Usually, there is no progression from the stage of liver disease. Ursodesoxycholic acid (UDCA) treatment should be continued for the duration of pregnancy and breastfeeding. There are very few published data from pregnant women exposed to UDCA, but no worrying signal have been reported. Pruritus de novo or worsening of pre-existing pruritus can occur in 50% of cases. There is an increasing risk of spontaneous termination of pregnancy. During pregnancy in women with primary sclerosing cholangitis, liver tests remain usually stable. There is an increasing risk of prematurity and cesarean birth. Pregnancy in women with autoimmune liver disease can lead to maternal and fetal problems.