Women with PBC may be at high risk of disease flares after childbirth
'Significant number' of liver disease patients had flares within 6 months: Study
Women with primary biliary cholangitis (PBC) may be at increased risk of having disease flares in the months following childbirth, according to a small study in China.
While three patients with the liver disease had flares during pregnancy, the retrospective study found double that number experienced an increase in markers of liver damage postpartum, specifically during the initial six months after giving birth.
These findings suggest that “close monitoring is necessary” for “reproductive-age patients with PBC” — a group for whom data is scant, per the scientists.
“Although most patients with PBC could maintain [disease] stability during pregnancy, a significant number of patients experienced … flares within the first [six] months postpartum,” the researchers wrote. “These data suggest that the postpartum period may constitute a risk factor for … flares in patients with PBC.”
The study, “Postpartum may be a risk factor for biochemical flares in patients with primary biliary cholangitis: A single-center experience,” was published in the journal Clinical Rheumatology.
PBC is a chronic, autoimmune form of cholangitis, or inflammation of the series of tubes that normally carry the digestive fluid bile out of the liver and to the intestines. This inflammation can disrupt normal bile flow and cause liver damage.
Scant attention paid to pregnancy in women with PBC
The condition mainly affects female, middle-aged individuals, but the researchers noted that “heightened awareness of diseases and the widespread adoption of health screening have contributed to the identification of patients with earlier-stage PBC, notably young women in their childbearing years.”
The researchers noted that “though these women have reproductive needs, the management of pregnancy in women with PBC has not received adequate attention.”
Pregnancy has a wide range of complex effects on the body, and has been reported to alter disease activity in people with other autoimmune conditions, such as lupus. However, there’s minimal data on how pregnancy affects PBC activity.
As a step toward addressing this gap, a team of scientists from Peking Union Medical College Hospital in Beijing retrospectively analyzed maternal and infant outcomes of 28 pregnancies in 20 women with PBC who were followed at their center between 2016 and 2023.
The women’s mean age at PBC diagnosis was 32.9, and they were, on average, 31.5 at the time of pregnancy. A total of 16 pregnancies occurred within two years before a PBC diagnosis, while 11 pregnancies came after a diagnosis. One woman was diagnosed with PBC during pregnancy.
Most (77.8%) of those who got pregnant after a PBC diagnosis were classified as having early disease. Also, 33.3% reported itching and 44.4% reported fatigue, two common PBC symptoms.
6 maternal adverse events reported, mostly high blood pressure, diabetes
A total of six maternal adverse events (21.4%) were reported, most commonly related to high blood pressure and diabetes. Most pregnancies (82.1%) resulted in live births, with two preterm births, or babies born before 37 weeks of gestation. Five of the pregnancies (17.9%) resulted in miscarriages — a rate that is in line with that reported in the general population.
Nine pregnancies in women with a prior PBC diagnosis led to the delivery of a full-term baby. Initial treatment in all cases was ursodeoxycholic acid, known as UDCA (sold as Urso and Actigall), the standard first-line PBC therapy. Five of the women stopped taking UDCA during pregnancy, while the other four continued on the medication.
No problematic side effects for mother or infant were documented for women who continued to use UDCA during pregnancy.
“UDCA treatment appears to be safe during pregnancy, but close follow-up is necessary,” the researchers wrote.
Disease flares seen in 3 women during pregancy, but 6 after birth
Biochemical flares — that is, a sudden increase in markers of liver damage — were reported in three women during pregnancy, the data showed. Two of them had continued on UDCA, while one had discontinued treatment.
“Most patients were able to maintain biochemical stability during pregnancy, with good maternal and infant outcomes,” the researchers wrote.
However, in the six months after birth, flares were reported in six women. These included all four women who’d continued UDCA during pregnancy. Flares were also experienced by one woman who stopped the drug during pregnancy, and one woman diagnosed with PBC during pregnancy, who did not receive medication.
Our data suggest that most patients with PBC can maintain relatively stable hepatic [liver] function during pregnancy but are prone to biochemical flares after delivery.
The higher flare rate in women who continued taking UDCA can be explained by the fact that these patients had generally more severe disease — which is likely why they chose to continue taking medication during pregnancy — the researchers noted.
According to the scientists, while 70% of women “maintained relatively stable biochemical measures during pregnancy,” the postpartum period “presented a notable concern, with 60% (6/10) of patients experiencing biochemical flares within [six] months postpartum.”
These data suggest that women with PBC may be at high risk of flares after birth, though the researchers noted that their results are limited to a few women followed at a single center. More broadly, the scientists said these findings emphasize the need for more formal research about how best to care for women with PBC during and after pregnancy.
“Our data suggest that most patients with PBC can maintain relatively stable hepatic [liver] function during pregnancy but are prone to biochemical flares after delivery,” the team wrote.
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