Management and outcome of pregnancy in autoimmune hepatitis

Background-There is a paucity of data in the literature on the risks associ ated with, and optimal management of, pregnancy in patients with autoimmune hepatitis (AIH). Aims-To assess maternal and fetal outcomes in relation to clinical manageme nt of pregnancy in a large cohort of patients with well defined AIH. Methods-A review of all known pregnancies in 162 females with definite AIH attending our clinics between 1983 and 1998, with respect to treatment, nat ural history, and outcome. Results-Thirty one live births (one twin) resulted from 35 pregnancies in 1 8 women (seven with cirrhosis). Median age at conception was 28 years (rang e 18-36). Two patients presented with AIH de novo during pregnancy. At conc eption, in 15 pregnancies patients had been receiving azathioprine alone or (in nine) with prednisolone, in seven prednisolone alone, and in one cyclo sporin. Fetal loss at greater than or equal to 20 weeks' gestation occurred in two instances patients had been receiving azathioprine alone or (in nin e) with prednisolone, in seven prednisolone alone, and within three months or delivery in a further four. Among the 31 children born (median follow up 10 years) only two abnormalities have been identified: Perthes' disease in one and severe mental and physical handicap in a second who was born prema turely following decompensation of the mother's liver disease. Neither moth er was receiving azathioprine. Conclusions-Successful completion of pregnancy is a realistic expectation f or patients with well controlled AIH. Treatment options vary, but azathiopr ine appears to be generally safe and without adverse outcomes for mother or baby. Vigilance is required, however, and patients need to be monitored ca refully during pregnancy and for several months post partum.