Pregnancy Outcomes Appear Favorable in Patients with Rare Liver Diseases PBC and PSC

Pregnant individuals with primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) generally experience favorable pregnancy outcomes, with risks largely mirroring those of unaffected pregnancies, according to research presented at the 2026 Society for Maternal-Fetal Medicine (SMFM) Pregnancy Meeting.¹ However, those with PSC may face a heightened risk of developing intrahepatic cholestasis of pregnancy (ICP).

Understanding PBC and PSC

PBC and PSC are uncommon, chronic liver diseases characterized by progressive damage to the bile ducts.² Historically, research on these conditions in relation to maternal health has been limited, creating uncertainty for clinicians managing pregnant patients with these diagnoses.¹ Clinical guidance has often been extrapolated from studies on intrahepatic cholestasis of pregnancy (ICP).

Large-Scale Study Reveals Insights

To address this knowledge gap, researchers conducted a retrospective, population-based study using data from the TriNetX research network, encompassing 106 US healthcare organizations.¹ The study analyzed data from over 5 million pregnant individuals (aged 12-55 years) between 2000 and 2025, comparing those with PBC and PSC to a control group.

The primary outcomes assessed included the incidence of ICP, preterm delivery, preeclampsia, postpartum hemorrhage, gestational diabetes, fetal growth restriction, cesarean section and stillbirth.¹

Key Findings

• PBC and PSC were identified in 0.009% (480 patients) and 0.006% (292 patients) of the pregnant population, respectively.¹
• Approximately 40% of patients in both the PBC and PSC groups were prescribed ursodeoxycholic acid during pregnancy.¹
• After adjusting for other factors, patients with PSC showed a significantly increased risk of developing ICP compared to the control group.¹
• No significant differences were observed in other pregnancy outcomes between individuals with PBC and those without the condition.¹

Clinical Implications

The study findings suggest that continuing the use of ursodeoxycholic acid and standard antenatal surveillance during pregnancy is appropriate for patients with PBC, and PSC.¹ The primary risk appears to be associated with the development of ICP, particularly in those with PSC.

“Pregnancy outcomes in patients with PBC and PSC are overall favorable,” the authors concluded. “Pregnant individuals with PBC and PSC had similar risk profiles compared with unaffected pregnancies, apart from a significantly increased risk of ICP in the PSC cohort.”¹

What is Primary Biliary Cholangitis?

Primary biliary cholangitis (PBC) is an autoimmune disease where the bile ducts in the liver become inflamed and are slowly destroyed.² Bile, produced in the liver, aids digestion, vitamin absorption, and waste removal.² The inflammation can lead to cirrhosis of the liver.² PBC was previously known as primary biliary cirrhosis.

What is Primary Sclerosing Cholangitis?

Primary sclerosing cholangitis (PSC) is a chronic liver disease that damages the bile ducts, making it tricky for bile to flow.² This backup of bile can cause liver damage and eventually lead to cirrhosis.²

Reference

1. Gaur P, Kushner T, Leipsner EJ, Johnson K. 1218: Pregnancy outcomes in primary biliary cholangitis and primary sclerosing cholangitis: a national cohort study. Poster presented at: 2026 SMFM Pregnancy Meeting; February 8-13, 2026; Las Vegas, NV.
2. Primary Biliary Cholangitis (PBC). Cleveland Clinic. Accessed February 19, 2026.