Biliary atresia: is maternal infection a risk factor?

A case-control study investigated whether a maternal infection during pregnancy can increase the child's risk of developing biliary atresia.

Maternal infections as a possible risk factor for biliary atresia

• Children whose mothers suffered a gastrointestinal or urinary tract infection during pregnancy had a significantly increased risk of biliary atresia.
• In particular, if these infections occurred in the third trimester, they were associated with an increased risk of atresia.
• No connection could be established between the foetal liver disease and other infections of the mother, such as influenza.

What is biliary atresia?

Biliary atresia (BA) is a rare liver disease during childhood. The disease is one of the main reasons for liver transplantation in paediatric patients. BA pathogenesis has not yet been conclusively clarified, but there are various theories. The consensus is that the disease probably develops after viral infections in the neonatal period. This leads to inflammation and eventually fibrosis of hepatocytes and cholangiocytes.

However, there are also more studies that suggest that the development of BA already begins during pregnancy and in utero. Little research has been carried out into the role that an infection of the mother during the gestation period could play in this. A study team from Taiwan has focussed on precisely this topic.

A detailed case-control study

Using Taiwan's insurance system, health data became available for almost the its population of around 23 million people. Over the predefined study period, the researchers were able to identify 447 children with BA. Almost 3,000 healthy children born during the same period were then randomly selected as controls. The study's aim was to find out whether an infection in the mother during pregnancy increases the risk of biliary atresia. The infections included were.

• Gastrointestinal infections
• Influenza
• Pneumonia
• Upper respiratory tract infections
• Urinary or genital tract infections
• Soft tissue infections

Is maternal exposure to viruses or bacteria a risk factor?

The researchers found that children whose mothers suffered from gastrointestinal, gynaecological, or urinary tract infections during pregnancy had a significantly increased risk of suffering from BA. No corresponding correlation could be established for the other bacterial and viral infections. Of particular interest: maternal infection in the third trimester was associated with a particularly high risk of BA.

Conclusion for medical practice

The data suggest a link between maternal gastrointestinal or urogenital infections and the development of biliary atresia. Further studies could provide more information about the pathogenesis of the disease, but also reveal possibilities that could contribute to the prevention of the disease.