Autoimmune hepatitis among fertile women: strategies during pregnancy and breastfeeding?
OBJECTIVE
In published studies there is a lack of data about the risks, management and how women with autoimmune hepatitis (AIH) decide on and are advised about pregnancy. The aim of this study was to investigate how women with AIH consider pregnancies, are advised and pharmacologically treated, as well as the outcome.


METHODS
A questionnaire was mailed to 128 women with AIH diagnosed during their fertile period and data from the Swedish National Birth Register was also used for matched controls.


RESULTS
There was an 83% response rate to the questionnaires. Sixty-three pregnancies were reported by 35 women. 48% did not consult their doctors before getting pregnant. More than half of the women reduced or stopped the immune suppression during pregnancy or breastfeeding. Some women were advised to abstain from pregnancy or even to have an abortion. Caesarean sections were performed more frequently in the AIH group (16% compared with 6.5% in the control group p<0.01). There were no significant differences in the number of stillborn infants or infants with malformations. However, 30% of the patients experienced flare-up after delivery.


CONCLUSIONS
In general, the outcome of pregnancy in women with AIH seems to be good. Current pharmacological treatment appears to be safe, including azathioprine during pregnancy and lactation. After delivery an active preparedness to increase pharmacotherapy should be considered.
Werner
Mårten
M
Departments of Medicine, Sections for Hepatology and Gastroenterology, Umeå University Hospital, Umeå, Sweden. marten.werner@vll.se
Björnsson
Einar
E
Prytz
Hanne
H
Lindgren
Stefan
S
Almer
Sven
S
Broomé
Ulrika
U
Wallerstedt
Sven
S
Sandberg-Gertzén
Hanna
H
Hultcrantz
Rolf
R
Sangfeldt
Per
P
Nilsson
Jenny
J
Danielsson
Ake
A
D000328:Adult; D000368:Aged; D001942:Breast Feeding; D005260:Female; D005298:Fertility; D019693:Hepatitis, Autoimmune / Q000188:drug therapy*; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011795:Surveys and Questionnaires