Treatment of Autoimmune Hepatitis During Pregnancy

Managing autoimmune hepatitis (AIH) in a pregnant patient requires careful review of the existing immunosuppressive regimen. The clinical priorities shift — some treatments must be continued to prevent relapse, while others carry specific risks that change the therapeutic approach before and during pregnancy.

Clinical scenario

Pregnancy in a patient with autoimmune hepatitis — whether the patient is already established on maintenance therapy or presenting with AIH for the first time during pregnancy. The safety profile of the immunosuppressive regimen must be reassessed in this setting.

Treatment approach

The approach involves continuing thiopurine-based maintenance therapy, with consideration of corticosteroids, through pregnancy. One commonly used agent in AIH is contraindicated during pregnancy and must be addressed well before conception. For patients presenting with AIH for the first time during pregnancy, the protocol specifies which standard regimen applies and what must be excluded. The full sequenced, evidence-graded protocol is available below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.jhep.2025.03.017

Maintenance treatment with thiopurines (±corticosteroids) should be continued during pregnancy (LoE 3, strong recommendation, strong consensus).
MMF should be withdrawn at least 3 months before conception (LoE 2, strong recommendation, strong consensus).
In first presentations of AIH during pregnancy, standard therapeutic regimens (excluding MMF) should be utilised (LoE 2, strong recommendation, strong consensus).

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