While women with primary biliary cholangitis (PBC) can experience successful pregnancies and have healthy babies, complications may still occur. On rare occasions, PBC can also be diagnosed during pregnancy.
The average age of diagnosis of PBC is around 40 years of age, with onset of the disease often beginning from the age of 30. As a female-dominated disease, 90% of people with PBC are women.
PBC is a rare, chronic autoimmune liver disease, which progressively destroys the bile ducts within the liver. This inhibits the flow of bile, causing it to build up in the liver, leading to scarring, damage to liver function and ultimately, liver failure. The exact cause of PBC is not known, but risk factors include age, sex, genetic factors and environmental factors.
The two main symptoms of PBC are fatigue and pruritus (itchy skin), as well as brain fog, abdominal pain, indigestion and jaundice. However, many people are asymptomatic at diagnosis.
There is no cure for PBC, but timely treatment slows the progression of the disease and helps manage symptoms to preserve quality of life. Once the disease progresses to end-stage liver failure, a liver transplant is the only option.
Learn more about PBC treatment and care
Challenges during pregnancy
Pregnancy outcomes will depend on factors such as overall health and the stage of PBC. Women with well-controlled PBC will have the most favorable outcomes. If you have PBC and you’re planning to become pregnant, you will require pre-pregnancy counseling with a team of experts, including your obstetrician and hepatologist.
Managing PBC symptoms, particularly fatigue and itchy skin, at the best of times can be challenging. During pregnancy it can be a heavy burden. Sleep and quality of life can be impacted, leading to depression and self-isolation.
Fortunately, the first-line treatment of PBC is considered safe and may be continued to be taken during pregnancy. Ursodeoxycholic acid (UDCA) helps delay liver damage and will help keep the disease stable during pregnancy.
Risks during pregnancy
For some women, pregnancy can exacerbate PBC symptoms or worsen the condition. The risk of miscarriage and preterm delivery is also higher in pregnant women with PBC. This may be due to hormones – estrogen in particular – and a lowered immune response during pregnancy.
In cases of PBC that have advanced to fibrosis or cirrhosis, it may be harder to become pregnant and during pregnancy, risks are higher for mother and baby. Specialized care is required throughout pregnancy and birth.
Post-partum biochemical flares are common in women with PBC, meaning an increase in symptoms and disease activity post-delivery.
