Autoimmune hepatitis and pregnancy: considerations for the clinician

ABSTRACT

Introduction

Autoimmune hepatitis (AIH) is an immune-mediated inflammatory disease of the liver, which affects females of reproductive age. AIH poses unique challenges in pregnancy and historically was associated with adverse pregnancy outcomes.

Areas covered

This report aims to review the current evidence for AIH pregnancy outcomes and the use of medical therapies in pregnancy. The disease course of AIH in pregnancy including loss of biochemical response (LOBR) and hepatic decompensation is also reviewed. The importance of preconception counseling and continued monitoring into the post-partum phase is reinforced.

Expert opinion

The lack of prognostic markers and targeted immunosuppression is some of the areas for future development, as this will aid the move toward individualized risk stratification and personalized care.

KEYWORDS:

• Autoimmune hepatitis
• pregnancy
• outcome
• Treg
• cirrhosis
• immunosuppression

Abbreviations

Table

Article highlights

• Preconception counselling is a crucial opportunity to optimise and counsel AIH patients wishing to become pregnant.

• AIH patients with cirrhosis should have variceal screening with endoscopy in the second trimester and consider magnetic resonance imaging for abdominal/ pelvic varices in patients with low platelets.

• AIH patients can achieve favourable pregnancy outcomes with the appropriate multidisciplinary approach.

• Development of prognostic markers in AIH pregnancy would aid individualised risk stratification and surveillance strategies to be made.

• Current immunosuppression therapy carries risks/side effects which need to be considered during AIH pregnancy and in future, targeted therapeutic agents with narrower side effect profile is required.

Conflict of interest

MA Heneghan is supported by the European Association for the Study of the Liver Registry Grant (Liver Disease in Pregnancy), The King’s College Hospital NHS Trust Charity (Orpin Bequest), and The Kelly Group. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer statement

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.