title: Follow-up of pregnant women with autoimmune hepatitis: the disease behavior along with maternal and fetal outcomes.
abstract: OBJECTIVE
  To assess maternal and fetal outcomes and clinical management of pregnancy in patients with autoimmune hepatitis (AIH).
  
  
  BACKGROUND
  There is a paucity of information about maternal and fetal outcomes, and AIH activity during pregnancy and in the postpartum period. There is no consensus about the administration of azathioprine during pregnancy and breastfeeding.
  
  
  METHODS
  Retrospective analysis of 54 pregnancies (3 still in progress) in 39 AIH patients.
  
  
  RESULTS
  The median age at conception was 24 years, and 68.4% of women had liver cirrhosis. Before conception and in early pregnancy, azathioprine and prednisone were administered in 48.1%, but treatment regimen was usually changed further to 20 mg/d prednisone; and 20.4% were off treatment. There were 36 livebirths, and fetal loss rates were 29.4% (13 miscarriages, 1 stillbirth, and 1 ectopic pregnancy). Preterm birth rate was 11.8%. In 2 cases, there was acute fetal distress; and in 2 others congenital malformations (3.9%). The rate of serious maternal complication was 7.8%, with no deaths. There were no flares in 41.2% pregnancies, but aminotransferase elevations occurred in 54.9%, 31.4% of which were true AIH relapses, only registered in the postpartum period.
  
  
  CONCLUSIONS
  Despite the high fetal miscarriage rate, pregnancy in AIH was safe. Patients needed careful monitoring, especially in the postpartum period because of relapses. There was no evidence of a cause and effect relationship among azathioprine administration and premature births and congenital abnormalities, but more studies are necessary. Higher doses of prednisone may be an alternative option for those who prefer azathioprine withdrawal during pregnancy.
authors.affiliation: Department of Gastroenterology, Institute of Tropical Medicine, University of São Paulo School of Medicine, Sao Paulo, SP, Brazil.
authors.forename: Debora Raquel B
authors.initials: DR
authors.lastname: Terrabuio
authors.forename: Clarice Pires
authors.initials: CP
authors.lastname: Abrantes-Lemos
authors.forename: Flair José
authors.initials: FJ
authors.lastname: Carrilho
authors.forename: Eduardo Luiz R
authors.initials: EL
authors.lastname: Cançado
mesh_terms: D000022:Abortion, Spontaneous; D000293:Adolescent; D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use; D000013:Congenital Abnormalities; D005260:Female; D019693:Hepatitis, Autoimmune / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007231:Infant, Newborn; D007234:Infant, Premature; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D011256:Pregnancy Outcome; D047928:Premature Birth; D011379:Prognosis; D012307:Risk Factors; D050497:Stillbirth; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D001379:Azathioprine