PBC & Pregnancy

[Betonarme]

Hi Everybody,

I've jost joined. We're also confronted with PBC since hmmmm...2 Weeks or so....very fresh :(.

Since my wife was complaining about some unspecific pain on right upper side of the belly. We decided to

go to a doctor to check the gallbladder first.

To keep it short the story, at the End with the help of certain Blood parameters(gamma-GT, ALP and postive AMA) one Doctor said this is PBC!

My wife was pregnant last year and in the last couple of weeks she started itching...she then found out that it should be so called "Intrahepatic cholestasis of pregnancy", she took Ursodeoxycholic Acid but didn't help much against ithcing, we decided(togoether with doctors) to bring the baby earlier to world than was calculated.

Baby got no Harm from the toxics in mothers blood and after the Birth my wife was Ok, itching was gone.

We also now know the Blood paramaters(related to Liver) during the whole pregnany quite well.

(and also before the pregnancy)

ALP and Gamma-GT was quite normal until the Cholestasis started. We only don't know the AMA before and during the pregnancy.

Last time I asked to Doctor that, whether the pregnancy can trigger the PBC? He said, "It's known that Pregnancy can provoke some immunological processes in the body".

Now, I know that it won't help much to know it, but I'm still curious about the relationship between Pregnancy and PBC.

Does Anyone know any avaliable data on that?

[Blossompossum]

Hi there. I am sorry to hear the bad news.

As far as I know there is no link. The body always suppresses the immune system when pregnant so that the body doesn't attack the baby as it is half the mmothers DNA and half the father's.

I am now pregnant with our 4th and all of my.blood tests have gone back to perfect. GGt and alp all normal.

From all the journal articles I have read if the ggt and alp or alt are elevated along with a positive ama then that is enough to diagnose pbc.

Has she had a lover biopsy to diagnose her stage?

[Betonarme in reply to Blossompossum]

Hi, Thanks for sharing your information.

No, for now we decided not to biopsy since 2 different doctors said it makes not much sense for now and they also say they can monitor the disease with blood parameters better.

We assume for now the pbc must be in the early stage because all her liver parameters were normal 1 year ago. Well....we'll see.

Otherwise we are monitoring the Intercept's web page for announcements of new medicament (OCA). They say this new medicament might launch in 2015 in Europe(if I understand it correct). They are also working on a new medicament called INT-767 which they claim should be better than OCA....

[Hidden in reply to Betonarme]

I never had a biopsy and I wouldn't agree to one now anyway if offered. I am in the UK and if you have the criteria (ie symptomatic (I was itching and fatigued back in 2010), abnormal LFTs and GGT plus positive AMAs) then that is enough to diagnose PBC.

I have no interest whatsover in knowing whatever stage I am at with PBC as each stage can last a very long time and in some cases never progress to another level and regardless it will not alter anything, I'll still for now be taking urso.

As long as your wife is doing well for now and she has normal LFTs then she is doing great I'd say. My LFTs have not as yet gone back to normal, they may never do but they have decreased somewhat from starting urso Dec 2010.

I have read up on the OCA and it is featured in this issue of Bear Facts I notice. My doubts with this OCA is that it can cause itching and I itch already and don't fancy itching moreso than I do now if it was recommended once it may be marketed taking that as opposed to urso without adequate reason.

[tigger_7]

So far as I know there is no link between the both. Some women find out they have it when they are pregnant because they might start itching or their LFT are strange, but they've had it unknowing for a while as unless you have a physical symptom I don't think anyone would know they had a liver problem. There is the OC you talked about but the liver recovers and the LFT's go back to normal after giving birth and yes for some reason pregnancy brings it on. There is a charity called ICP support.org all about Intrahepatic cholestasis of pregnancy,

the lady who started it is lovely, I meet her while being referred to london hospital to see liver specialist when pregnant. She knows a lot so you could ask her some questions.

I was diagnosed just as I found out I was pregnant back in 2009. The urso didn't touch the itching I had until 4 months after giving birth. We did the same as you, I was induced early at 35 as the doctors didn't want me to go full term. The second time I was pregnant, they were a bit more relaxed (not so many blood tests or scans!) and induced at 36 weeks. Both babies were fine. But I'm not sure my liver came out well after both of the pregnancies, as it puts a lot of pressure on the liver and since it is not working great normally I think it struggled through my pregnancies. Anyway since I'm not going to get pregnant again, my liver will stay as it is.

Glad everything went ok with your wife and her pregnancy. Good luck with it all.

[Betonarme in reply to tigger_7]

According to Wikipedia ICP and OC are same thing. I'm still not sure if they really are..didn't read on about them enough actually.

Anyway, but I think not every woman who develops OC / ICP during pregnancy has/had or will have PBC later.

Since We don't know the AMA value before the pregnancy it's very difficult to say Pregnancy triggers PBC or not. But from the blood values it's very clear that she had normal LFT before pregnancy. So it just remains as a suspect for me.

Thanks

[Laurie86 in reply to Betonarme]

Hello, sorry I know it's a late reply to the thread.

I believe that intra hepatic cholestasis of pregnancy is the same thing as obstetric cholestasis.

By definition oc is itching without a rash in pregnancy, with abnormal liver function/bile acids- which returns to normal after delivery.

When these blood tests don't return to Normal say when they're checked 6 weeks postnatally, that's when you question whether there is more to it- like underlying pbc.

And people with pbc are more likely to get oc when pregnant.

Hope your wife is ok.

Laurie

[Hidden]

Hello Betonarme.

Welcome.

Sorry I cannot be of any help regarding your question but as far as I am concerned here (diagnosed PBC 3 1/2 yrs ago. I am now 50), it's said that it is unknown how PBC actually starts up. Thought to be one of a few things from environment to an infection possibly. It apparently affects mostly woman, a few percentage of men.

I had the AMA blood check back in later 2010 and all I got informed in writing via the hospital consultant was that I had a 'high titre' of the AMAs and along with abnormal and elevating LFTs (liver function test) and itching (reason I took myself off to see GP early 2010) it was enough to diagnose PBC.

Now I am a mother of 2 grown-up children and in both my pregnancies back in the 1980s I had no problems at all throughout the both. Just suffered a few months of nausea in the early days of pregnancy and had no problems with delivery either.

I have read about cholestatis in pregnancy years ago and as far as I know some pregnant women can find themselves itching in later pregnancy which is due to this but it seems that the LFTs are taken and I expect some women are found to have abnormal ones, others normal. (I have a friend who has just become a granny and her daughter suffered ithcing later stages of pregnancy but her LFTs were found to be normal and other bloods that were done.)

Quite frankly I'd not concern myself with the readings of your wife's bloods during her pregnancy. Having AMAs of a certain reading that gave the result of PBC won't change the diagnosis especially if she had abnormal bloods and also the itching.

I think like myself developing PBC when I was 46, it just seems pretty bad luck for us all. All we can now do is just to enjoy our lives, yourself with your wife and baby (and anymore children you may have already or in future) and deal with things as and when they come along.

Out of interest I myself am intrigued if everyone who has PBC who contributes to this site has had a baby or babies. But thinking further would there be a connection here as there are men on this site with PBC? So thinking this way, I very much doubt that a pregnancy would be cause for a development of PBC unless it is something that is hormone-related?

[mumofthree]

Hi Betonarme

Sorry I can't help regarding the data. However since being diagnosed with PBC I too have wondered if was related to my last pregnancy (1998). I was diagnosed with PBC in Jan 2011 my symptoms being joint, bone and muscle pain. 8/10 weeks after giving birth 6 weeks prematurely I started having symptoms of severe pain in my hands, elbows, feet and knees I had not experienced anything like that before. I could not pick up my child, I had to scoop him into my arms and I had to either be carried up or down the stairs by my husband or go up and down them on my bottom. My GP thought I could possible have Viral arthritis and referred me to a rheumatologist who did not think I had arthritis but could not offer an alternative diagnosis or provide any reason why I was experiencing this pain. It was not until 2011 that I finally got a diagnosis - PBC diagnosed in Jan 2011 by gastroenterologist and a few months later a rheumatologist diagnosed osteoporosis of the spine and osteoarthritis of the hands, elbows, feet and knees. I have my suspicions of a possible link between the two as these pains started shortly after pregnancy and have been with me ever since. By the way I do not and have not had symptoms of the itch.

[mb309]

I don't have any book data for you, but this is my story... I was officially diagnosed with PBC 9 months after giving birth to my son (1st and only child). He was born 6.5 weeks early via emergency cesarean section as I was hemorrhaging due to placental abruption. After delivery my obgyn suggested that I see a hematologist to discuss my blood clotting disorder (which played a part in me having the placental abruption) to develop a 'life plan' for what to do regarding the care of my blood (take blood thinners? if so, which one, etc) for the duration of my life. They did a large battery of bloodwork on me and while I was visiting with her (about 6 months after delivery) she too had shared that she saw a parallel between women and pregnancy and either being diagnosed during or after with auto-immune diseases. (Keep in mind at this point I had not yet been diagnosed!) She was taking my family history where I told he my paternal aunt had 3 autoimmune diseases (none of which are pbc.) Anyways, I was not displaying any symptoms at my diagnosis. I had simply gone to my internal medicine doctor for routine bloodwork. Thankfully I'm still asymptomatic.