Alcohol-Associated Hepatitis Linked to Adverse Pregnancy Outcomes

Women with alcohol-associated hepatitis (AH) are less likely to become pregnant and are more likely to experience adverse pregnancy-related outcomes, according to findings from a recent study.1

Leveraging data from the TriNetX Research Network, findings from the analysis suggest that although patients who experience pregnancy after AH face an increased risk of adverse pregnancy outcomes, they may experience delayed progression of liver disease and more favorable long-term outcomes compared with nonpregnant counterparts.1

“With the rising rates of AH in young women, it is likely that pregnancies following AH will become more common in clinical practice, and having the knowledge to counsel these patients will be increasingly important,” Katherine Cooper, MD, a resident physician at the University of Massachusetts Chan Medical School, and colleagues wrote.1

AH is a severe syndrome of alcohol-associated liver disease and is characterized by rapid onset of jaundice, malaise, tender hepatomegaly, and subtle features of systemic inflammatory response.2 Although existing data point to poorer pregnancy outcomes in AUD and alcohol-associated cirrhosis, these findings may not apply to women with recent AH, a population for whom limited research exists.1

To evaluate the incidence of pregnancy, pregnancy-related outcomes, and liver-related outcomes in reproductive-aged patients with AH compared with healthy controls, investigators analyzed data from the TriNetX Research Network.1

They calculated the incidence of pregnancy for 3 groups: women 18–45 years of age with ≥ 1 episode of AH; women 18–45 years of age with alcohol use disorder (AUD); and women 18–45 years of age with no history of AUD, AH, liver or biliary disease. Incidence rates were reported as cases per 1000 person-years and compared using incidence rate ratios.1

Pregnancy-related outcomes were assessed in pregnancy events occurring in women 18–45 years of age between January 2014 and December 2023. The AH group included pregnancies that occurred within 3 years of an AH diagnosis and the control group consisted of pregnancies with no prior history of liver or biliary disease. Groups were propensity score matched, and pregnancy-related outcomes were defined using ICD-10 codes for 12 months after the index pregnancy event.1

Additionally, liver-related outcomes were compared in women with AH who experienced a subsequent pregnancy and those with AH who did not experience a subsequent pregnancy. Propensity score matching was again used to create cohorts balanced by age, race, ethnicity, and bilirubin level. For this analysis, the follow-up period was 3 years.1

A total of 10,186 women 18–45 years of age were diagnosed with AH during the study period. Investigators noted the incidence of pregnancy was significantly lower in the AH cohort compared with healthy controls (26.6 vs 54.4 pregnancies per 1000 person-years; P <.001) and those with AUD alone (26.6 vs 43.8 cases per 1000 person-years; P <.001).1

They identified 531 pregnancies occurring within 3 years of an AH diagnosis. After matching, 1062 pregnancies were included in the analyses. The mean age was 32.7±5 years at the index pregnancy event and most pregnancies were in Caucasian and non-Hispanic women.1

Upon analysis, abortive outcomes were more common in AH pregnancies compared with control pregnancies (14.6% vs 8.0%; P <.001), and AH was associated with nearly 2-fold higher odds of spontaneous abortion (odds ratio [OR], 1.95; 95% CI, 1.16-3.28; P = .011).1

Maternal disorders related to pregnancy were also more common in AH pregnancies (39.0% vs 30.7%; P = .005). Specifically, AH was associated with greater odds of early pregnancy bleeding (OR, 1.78; 95% CI, 1.07-2.97; P = .024), excessive vomiting (OR, 2.46; 95% CI, 1.38-4.40; P = .002), genitourinary infections (OR, 2.22; 95% CI, 1.14-4.33; P = .017), and pre-eclampsia or eclampsia (OR, 2.89; 95% CI, 1.54-5.42; P = .001).1

Investigators additionally compared alcohol and liver-related outcomes in 896 women with AH, including 499 women with pregnancy following AH and 499 women without a subsequent pregnancy. They pointed out the cumulative incidence of cirrhosis was similar in women who experienced a subsequent pregnancy (18.1%) and in those who did not experience a pregnancy (19.4%), with no statistically significant difference observed in crude risk measures, but Kaplan-Meier survival analysis revealed a significantly lower hazard of cirrhosis among the pregnancy group (hazard ratio, 0.58; 95% CI, 0.41-0.81; log-rank χ²=10.4; P = .001).1

“The results of this study are important for reproductive counseling for women who experience AH and to inform future studies in this growing population of women,” investigators concluded.1 “They also highlight the importance of multidisciplinary care, including hepatology, obstetrics, and mental health services, to address the complex needs of this high-risk population.”

References

1. Cooper KM, Patel AK, Kaluri S, Devuni D. Pregnancy and liver-related outcomes after alcohol-associated hepatitis: A global multicenter study. Hepatol Commun. doi:10.1097/HC9.0000000000000663

2. Shah NJ, Royer A, John S. Alcoholic-Associated Hepatitis. StatPearls. June 5, 2023. Accessed March 7, 2025. https://www.ncbi.nlm.nih.gov/books/NBK470217/