SYSTEMATIC REVIEW WITH META-ANALYSIS: NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD), AUTOIMMUNE HEPATITIS (AIH) AND PRIMARY BILIARY CHOLANGITIS (PBC) IN PREGNANCY

Abstract

Background and Aims: Maternal and fetal outcomes in pregnant patients with Nonalcoholic fatty liver disease (NAFLD), Autoimmune hepatitis (AIH) and Primary biliary cholangitis (PBC) have been largely unexplored. This project aims to determine the level of evidence associated with maternal and fetal outcomes in pregnant women with NAFLD, AIH and PBC.

Method: We conducted a comprehensive literature search. The studies included pregnant patients with a diagnosis of NAFLD, AIH or PBC. We used a random-effects model using odds ratios (OR) with 95% confidence intervals (CI).

Results: Forty-seven studies were included in the analysis, the breakdown of studies and patients in each condition was NAFLD (n=22, 13,641), AIH (n=14, 1,452) and PBC (n=11, 2,179). In both NAFLD and AIH, pregnancy was associated with Pre-existing diabetes (OR= 6.00, 95% CI:2.21-16.31, P<0.001; n=7), (OR: 5.73, 95% CI: 2.73-12.02; p<0.001, n=2) respectively and Gestational diabetes mellitus (GDM) (OR=3.23, 95% CI: 1.97-5.31, P<0.001, n=6), (OR: 2.84, 95% CI: 1.78-4.54, P=<0.001, n=2) respectively. In PBC, pregnancy women had triple the odds of having pruritis or jaundice (OR = 3.37, 95% CI: 0.89- 12.82; P = 0.08; n=3) compared to the control group. All three conditions were associated with notably increased odds of premature birth, whilst NAFLD and AIH pregnancies showed a significant association with large for gestational age birth (OR=2.01, 95%CI: 1.72-2.37; P<0.001, n=2) and small for gestational age birth (OR:2.48,95%CI1.37-4.51; p=0.003, n=2) respectively.

Conclusion: This meta-analysis provides pooled evidence that NAFLD, AIH and PBC are associated with a notable association with a range of maternal and fetal outcomes. This data is important for clinicians managing these patients before, during and after pregnancy.