{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T10:23:04Z","timestamp":1779358984418,"version":"3.51.4"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","license":[{"start":{"date-parts":[[2021,5,21]],"date-time":"2021-05-21T00:00:00Z","timestamp":1621555200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatol Commun"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:p>Autoimmune hepatitis (AIH) is an immune\u2010mediated chronic liver disease that affects all ages, including women of childbearing age. Optimal management during pregnancy is poorly defined. We aimed to explore the clinical and biochemical course of AIH in the antenatal and postpartum periods, and assess factors associated with premature birth and postpartum flares. Pregnant women with AIH reviewed in the autoimmune liver disease clinic at the Queen Elizabeth Hospital Birmingham between 2009 and 2020 were identified retrospectively, and clinical, biochemical, and immunological data 1\u00a0year before conception to 1\u00a0year postpartum were collected. Analysis was performed to identify trends in blood markers over the antenatal period, with an interrupted time series approach used to assess postpartum trends. Data were available for n\u00a0=\u00a027 pregnancies (n\u00a0=\u00a020 women), with median gestation of 38\u00a0weeks (30% premature) and most having type 1 AIH (78%) and delivering via caesarean section (63%). Levels of alanine transaminase, aspartate transaminase, and immunoglobulin G all declined significantly during gestation, followed by significant step\u2010change increases after delivery. Postpartum flare developed in 58% of pregnancies. AIH type 2 was associated with a higher rate of premature births (67% vs. 19%, <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.044), and a trend toward a higher rate of postpartum flare (100% vs. 48%, <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.053). Although not significant, medication nonadherence was associated with almost double the risk of prematurity (40% vs. 24%, <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.415) and postpartum flare (80% vs. 44%, <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.109). <jats:italic toggle=\"yes\">Conclusion:<\/jats:italic> Biochemical and immunological remission of AIH occurs during pregnancy, although subsequent postpartum flare is common. Type 2 AIH is associated with a higher risk of premature birth and postpartum flare, although further research is required to validate and explain this finding.<\/jats:p>","DOI":"10.1002\/hep4.1714","type":"journal-article","created":{"date-parts":[[2021,5,21]],"date-time":"2021-05-21T10:44:42Z","timestamp":1621593882000},"page":"1252-1264","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":10,"title":["Type 2 Autoimmune Hepatitis and Nonadherence to Medication Correlate With Premature Birth and Risk of Postpartum Flare"],"prefix":"10.1097","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6299-7710","authenticated-orcid":false,"given":"Kathryn","family":"Olsen","sequence":"first","affiliation":[{"name":"University Hospitals Birmingham National Health Service Foundation Trust,Birmingham,United Kingdom"},{"name":"Center for Liver and Gastro Research,Institute of Immunology and Immunotherapy,University of Birmingham,Birmingham,United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Hodson","sequence":"additional","affiliation":[{"name":"University Hospitals Birmingham National Health Service Foundation Trust,Birmingham,United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincenzo","family":"Ronca","sequence":"additional","affiliation":[{"name":"University Hospitals Birmingham National Health Service Foundation Trust,Birmingham,United Kingdom"},{"name":"Center for Liver and Gastro Research,Institute of Immunology and Immunotherapy,University of Birmingham,Birmingham,United Kingdom"},{"name":"National Institute for Health Research Birmingham Biomedical Research Center,European Reference Network Rare\u2010Liver Center,University Hospitals Birmingham National Health Service Foundation Trust and University of Birmingham,Birmingham,United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amber G.","family":"Bozward","sequence":"additional","affiliation":[{"name":"University Hospitals Birmingham National Health Service Foundation Trust,Birmingham,United Kingdom"},{"name":"Center for Liver and Gastro Research,Institute of Immunology and Immunotherapy,University of Birmingham,Birmingham,United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Hayden","sequence":"additional","affiliation":[{"name":"University Hospitals Birmingham National Health Service Foundation Trust,Birmingham,United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grace","family":"Wootton","sequence":"additional","affiliation":[{"name":"University Hospitals Birmingham National Health Service Foundation Trust,Birmingham,United Kingdom"},{"name":"Center for Liver and Gastro Research,Institute of Immunology and Immunotherapy,University of Birmingham,Birmingham,United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Armstrong","sequence":"additional","affiliation":[{"name":"University Hospitals Birmingham National Health Service Foundation Trust,Birmingham,United Kingdom"},{"name":"Center for Liver and Gastro Research,Institute of Immunology and Immunotherapy,University of Birmingham,Birmingham,United Kingdom"},{"name":"National Institute for Health Research Birmingham Biomedical Research Center,European Reference Network Rare\u2010Liver Center,University Hospitals Birmingham National Health Service Foundation Trust and University of Birmingham,Birmingham,United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6776-0336","authenticated-orcid":false,"given":"David H.","family":"Adams","sequence":"additional","affiliation":[{"name":"University Hospitals Birmingham National Health Service Foundation Trust,Birmingham,United Kingdom"},{"name":"Center for Liver and Gastro Research,Institute of Immunology and Immunotherapy,University of Birmingham,Birmingham,United Kingdom"},{"name":"National Institute for Health Research Birmingham Biomedical Research Center,European Reference Network Rare\u2010Liver Center,University Hospitals Birmingham National Health Service Foundation Trust and University of Birmingham,Birmingham,United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omar","family":"El\u2010Sherif","sequence":"additional","affiliation":[{"name":"University Hospitals Birmingham National Health Service Foundation Trust,Birmingham,United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Ferguson","sequence":"additional","affiliation":[{"name":"University Hospitals Birmingham National Health Service Foundation Trust,Birmingham,United Kingdom"},{"name":"Center for Liver and Gastro Research,Institute of Immunology and Immunotherapy,University of Birmingham,Birmingham,United Kingdom"},{"name":"National Institute for Health Research Birmingham Biomedical Research Center,European Reference Network Rare\u2010Liver Center,University Hospitals Birmingham National Health Service Foundation Trust and University of Birmingham,Birmingham,United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ellen","family":"Knox","sequence":"additional","affiliation":[{"name":"Birmingham Women\u2019s Hospital,Birmingham,United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tracey","family":"Johnston","sequence":"additional","affiliation":[{"name":"Birmingham Women\u2019s Hospital,Birmingham,United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fiona","family":"Thompson","sequence":"additional","affiliation":[{"name":"University Hospitals Birmingham National Health Service Foundation Trust,Birmingham,United 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