The detrimental effect of autoimmune hepatitis in pregnancy: a systematic review and meta-analysis

Autoimmune hepatitis (AIH), a chronic inflammatory liver disease, poses unique challenges during pregnancy. In AIH, the immune response triggers inflammation, potentially leading to cirrhosis if left untreated. The study aims to provide comprehensive insights into the relationship between AIH and pregnancy, guiding clinicians in optimal maternal management.

Our meta-analysis includes data searched up to 1 January 2024. Eligibility criteria encompassed studies focusing on pregnant individuals with AIH, excluding case reports, letters, reviews, and incomplete papers. Data extraction, quality assessment using Cochrane risk of bias or Newcastle-Ottawa Scale, and quantitative analysis through Comprehensive Meta-Analysis were performed.

The literature search included 15 studies, involving 38 679 pregnant women with AIH across 10 countries. Maternal outcomes, such as disease flare [event rate (E) = 0.228, 95% CI: 0.13-0.36; P = 0.000] and maternal deaths, indicated significant associations. The incidence of gestational diabetes was higher in AIH patients (E = 0.091, 95% CI: 0.043-0.184; P = 0.001), showing notable heterogeneity. Fetal outcomes demonstrated significant associations with preterm births (E = 0.190, 95% CI: 0.131-0.268; P = 0.000), fetal loss (E = 0.142, 95% CI: 0.082-0.236; P = 0.000), and congenital anomalies (E = 0.041, 95% CI: 0.026-0.065; P = 0.000).

This systematic review contributes a comprehensive overview of the complex interplay between AIH and pregnancy, providing evidence for heightened risks and implications on maternal and fetal outcomes. Clinicians can leverage these findings for informed decision-making, while the study enriches the broader field of autoimmune and reproductive health.