Follow-up of pregnant women with autoimmune hepatitis: the disease behavior along with maternal and fetal outcomes.
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.
Terrabuio
Debora Raquel B
DR
Department of Gastroenterology, Institute of Tropical Medicine, University of São Paulo School of Medicine, Sao Paulo, SP, Brazil.
Abrantes-Lemos
Clarice Pires
CP
Carrilho
Flair José
FJ
Cançado
Eduardo Luiz R
EL
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
D007166:Immunosuppressive Agents; D001379:Azathioprine