Pregnancy introduces important considerations for the ongoing management of autoimmune hepatitis (AIH). The clinical priority is to preserve maternal hepatic stability while carefully accounting for the safety profile of each immunosuppressive agent during gestation.
A pregnant woman with established autoimmune hepatitis requires continued immunosuppressive management. Active treatment must be maintained throughout pregnancy to protect against disease flare — yet agent selection is directly constrained by pregnancy safety.
The cornerstone of management is continuation of maintenance immunosuppressive therapy throughout pregnancy. Not all agents used in AIH are appropriate in this setting — at least one commonly used option is contraindicated and must be strictly avoided. The structured protocol specifies which agents to continue and which to discontinue.
Maintenance of biochemical remission and avoidance of disease flare and hepatic decompensation throughout the pregnancy.
DOI: 10.1002/hep.31065
Maintenance doses of glucocorticoids and/or AZA should be continued throughout pregnancy.
AZA can be continued throughout pregnancy, whereas the use of MMF is contraindicated in pregnancy.
MMF is contraindicated during pregnancy, and women should be counseled about the adverse effects of MMF on pregnancy prior to initiating MMF treatment.
Patients with AIH who are pregnant or planning pregnancy within the next year should be continued on treatment to reduce the risk of flare and hepatic decompensation.
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