Improvement of autoimmune hepatitis during pregnancy followed by flare-up after delivery

Am J Gastroenterol. 2002 Dec;97(12):3160-5. doi: 10.1111/j.1572-0241.2002.07124.x.


Objectives: Pregnancy in autoimmune hepatitis has been a rare event, but it has become more frequent with improved therapy. The present study aimed to analyze the consequences for mother and child in patients with autoimmune hepatitis.

Methods: Fourteen pregnancies have been followed in five patients with autoimmune chronic hepatitis (AIH) and in one with autoimmune sclerosing cholangitis (overlap AIH-PSC).

Results: Features of AIH improved markedly from the second trimester of pregnancy onward, allowing a decrease in immunosuppressive therapy. After delivery (or stillbirth in one patient), the activity of the autoimmune disease flared up rapidly in 12 of 14 events.

Conclusions: Pregnancy induces a state of immune tolerance with improvement of the liver tests in AIH. This could result from a transition of TH1 to TH2 predominance during pregnancy. A flare-up often occurs after delivery. Preemptive increase of the immunosuppressive therapy is therefore advocated consecutive to delivery. Azathioprine use seems to be safe during pregnancy.

MeSH terms

  • Adolescent
  • Adult
  • Cholangitis, Sclerosing / drug therapy
  • Cholangitis, Sclerosing / physiopathology
  • Dose-Response Relationship, Drug
  • Female
  • Hepatitis, Autoimmune / drug therapy
  • Hepatitis, Autoimmune / physiopathology*
  • Humans
  • Immunosuppressive Agents / administration & dosage
  • Immunosuppressive Agents / therapeutic use
  • Postpartum Period / physiology*
  • Pregnancy
  • Pregnancy Complications / physiopathology*


  • Immunosuppressive Agents