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Medical Author:

John M. Vierling, MD, FACP

John M. Vierling, MD, FACP

John M. Vierling M.D. is Professor of Medicine and Surgery at the Baylor College of Medicine in Houston, Texas, where he also serves as Director of Baylor Liver Health and Chief of Hepatology. In addition, he is the Director of Advanced Liver Therapies, a center devoted to clinical research in hepatobiliary diseases at St. Luke's Episcopal Hospital. Dr. Vierling is board certified in internal medicine and gastroenterology and a Fellow of the American College of Physicians.

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Medical Editor:

Leslie J. Schoenfield, MD, PhD

Leslie J. Schoenfield, MD, PhD

Dr. Schoenfield served as associate professor of medicine and consultant in gastroenterology on the faculty of the Mayo Clinic for seven years. He became a professor of medicine in residence at UCLA from 1972 to 1999 (now emeritus). He was the director of gastroenterology at Cedars-Sinai Medical Center in Los Angeles for 25 years, where he received the chief resident's teaching award, the president's award, and the pioneer of medicine award.

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In this Article

• What is PBC?
• What is the scope of the problem?
• What is the cause of PBC?
• What are the symptoms and physical findings in PBC?
• What manifestations are specifically due to PBC itself?
• What are the manifestations of the complications of cirrhosis in PBC?
• What are the manifestations of diseases associated with PBC?
• What are risk factors for PBC?
• How is PBC diagnosed?
• What is the role of blood tests?
• What is the role of testing for antimitochondrial antibodies?
• What is the role of imaging tests?
• What is the role of liver biopsy?
• What are the criteria for a definitive diagnosis of PBC
• What is the course of natural progression in PBC?
• What are the sequential clinical phases of PBC?
• What is the role of mathematical models in predicting the outcome (prognosis) in PBC?
• What about pregnancy in PBC?
• Patient Comments: Primary Biliary Cirrhosis - Symptoms
• Patient Comments: Primary Biliary Cirrhosis - Diagnosis
• Find a local Gastroenterologist in your town
• Primary Biliary Cirrhosis Index

As discussed earlier, some women experience itching during their last trimester of pregnancy when the hormone levels of estrogens are high. A minority of these women may have a predisposition to develop PBC or may actually have early PBC that has not yet been diagnosed.

In the medical literature, pregnancy in women with an established diagnosis of PBC has not been reported frequently. While early reports suggested that the outcome was suboptimal for both fetus and mother, later reports indicated that women with PBC can deliver healthy babies. However, these women may develop itching or jaundice during the last trimester. Otherwise, the clinical course of PBC does not tend to worsen or improve during most pregnancies. Although some babies may be born several weeks prematurely, only one miscarriage has been reported. Furthermore, the risk of fetal abnormalities does not appear to increase in the pregnancies of PBC women.

Since advanced cirrhosis interferes with the processing (metabolism) of sex hormones, the likelihood of a woman with advanced liver disease becoming pregnant is small. Nevertheless, it is important to know that PBC patients who might become pregnant should not receive injections of vitamin A because it can cause birth defects (See the section on treatment of fat malabsorption). The chance that ursodeoxycholic acid therapy causes fetal harm is classified as remote but possible since adequate studies have not been done in pregnant women. The safety of ursodeoxycholic acid therapy taken by PBC mothers for their breast-feeding infants is unknown and considered controversial.