How is autoimmune hepatitis managed in pregnancy?

What does the evidence say about autoimmune hepatitis during pregnancy?

1. Disease activity and liver health before conception influence the pregnancy plan. Biochemical remission before pregnancy is associated with better disease control, while cirrhosis can add important risks. Ask the liver team what stability and preconception assessment mean for your individual situation. 1
2. Pregnancy medication choices are not interchangeable. Prednisone or prednisolone and azathioprine may remain part of specialist-directed care, while mycophenolate poses major pregnancy concerns. A positive test or pregnancy plan should prompt a specific medication review, not an assumption that all immune medicines must be stopped together. 2
3. Liver blood tests help monitor disease and medication effects. Feeling well does not supply the same information as the planned laboratory checks. Ask which tests are being followed and what changes should prompt a call rather than waiting for the next routine visit. 3
4. A systematic review found greater risk of loss of biochemical remission postpartum and increased preterm-birth risk in the studied populations. The findings support coordinated surveillance, particularly for people without established remission or with portal hypertension, rather than a prediction that every pregnancy will have complications. 4
5. Severe abdominal pain, confusion, persistent vomiting or feeling faint needs urgent assessment during pregnancy or after birth. Report the liver condition and all current medicines. New concerning symptoms should not be attributed to a familiar condition without review. 5

Before pregnancy, during pregnancy and after birth

• First trimester. Ask the liver team about disease stability and preconception medication review.
• Second trimester. Keep the agreed blood tests and coordinated maternity appointments.
• Third trimester. Confirm postpartum monitoring and an individualized breastfeeding medication plan.