AIH and Pregnancy

Autoimmune hepatitis (AIH) typically affl icts young women of childbearing potential, with frequent presentations including subfertility and amenorrhea. They may become pregnant, whether planned or unplanned.

Prominent issues concerning AIH in pregnancy include preconception counseling, maternal and fetal outcomes, intrapartum management, mode of delivery and postpartum management. Preconception management involves achieving good control with immunosuppression before conception; those in remission are more likely to conceive. Additionally, varices should be eradicated prior to conception. AIH in pregnant women follows a biphasic course, with improvement during pregnancy, but fl ares in the postpartum period unless well controlled on therapy.

New-onset AIH during pregnancy is rare due to the immune-suppressed state. Instead, consider the following in liver dysfunction in a pregnant lady: acute fatty liver of pregnancy (AFLP) or hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome or pre-eclampsia, acute viral hepatitis/acute liver failure and Budd-Chiari syndrome. There is an increased risk of preterm birth but no increased risk of stillbirths, congenital malformations or miscarriages. C-sections should not be pushed, and breastfeeding is encouraged. Pregnant women with AIH should be given low-dose aspirin between 12-16 weeks to reduce the risk of pre-eclampsia.

Well-controlled patients should continue on immunosuppressants such as steroids, azathioprine or tacrolimus. There may be a risk of increased gestational diabetes mellitus and hypertensive complications, necessitating aspirin to prevent pre-eclampsia. 

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