Pregnancy and liver-related outcomes after alcohol-associated hepatitis: A global multicenter study

Background: The incidence of alcohol-associated hepatitis (AH) is rising in women of reproductive age. While the adverse effects of alcohol on pregnancy are well documented, there is limited data on pregnancy in women with a history of AH. Methods: This study was completed by using the TriNetX Research Network. The primary objectives were to evaluate the incidence of pregnancy and related complications in pregnancies following an episode of AH (AH pregnancies) compared to pregnancies in healthy patients (control pregnancies). The secondary objective was to assess long-term liver-related complications and mortality in women with AH who experienced a pregnancy compared to no pregnancy. Propensity score matching was used for comparative analyses to balance cohorts by age, race, ethnicity, prior delivery, and obesity status. Results: The incidence of pregnancy was significantly lower in women with AH compared to controls (26 vs. 54 cases per 1000 person-years, p<0.001). AH pregnancies were associated with higher odds of spontaneous abortion (OR 2.0, 95% CI: 1.2 to 3.3, p=0.011), pre-eclampsia (OR 1.9, 95% CI: 1.1 to 3.0, p=0.002), peri-partum hemorrhage (OR 2.7, 95% CI: 1.3 to 5.6, p=0.007) and perinatal psychiatric disorders (OR 3.2, 95% CI: 1.6 to 6.2, p=0.001). The incidence of cirrhosis and hepatic decompensation were similar between women with AH who experienced a pregnancy compared to no pregnancy, but Kaplan Meier analysis revealed a significantly faster time to event in the no-pregnancy group. Conclusions: Pregnancies following AH diagnosis were associated with adverse pregnancy outcomes. Pregnancy after AH does not reduce the overall risk of developing advanced liver disease but may delay disease progression. These findings highlight the importance of tailored reproductive counseling and support for this population.