Autoimmune Hepatitis and Pregnancy

[Sabrina__0]

  I am a 26 year old female who has been living with autoimmune hepatitis for 9 years. I have been taking prednisone and immuran since I was diagnosed. I recently had to have a spleanal reneal shunt done for esophageal bleeding. I am now in good health with the exception of the autoimmune hepatitis. My husband and I would very much like to have a baby and I would think I should do it while I am still feeling well and not taking heavy doses of medication. I know that I will need a liver transplant and that after it I will be taking much more medication. I can not find any information about my condition related to pregnancy. I would like to know if I can pass this disease on to my baby? Will being pregnant harm me? Due to the medication I take I do not regularly menstrate. What would be the best way for me to get pregnant?

[HFHSM.D.-D.M.]

_
Dear Sabrina:
I appreciate your questions.  Unfortunately they are very difficult ones.  I understand that you are a 26 year old woman with autoimmune hepatitis since the age of 9 and you have been taking prednisone and imuran since diagnosis.  You state that you are not taking heavy doses of medication and you feel well but, there is a suggestion that you may have somewhat advanced disease because you recently had a spleno-renal shunt for variceal bleeding.  You want to know whether the pregnancy will harm you,  what  is the best way to get pregnant, and whether you will pass the condition on to your child.
I’ll answer your last two questions first.  It is very unlikely your child will inherit autoimmune hepatitis.  While, it can be difficult to make promises in medicine, I would not worry about this issue.  If you do decide to get pregnant, you and your husband might try for awhile with general advice from your physicians and if you are unsuccessful, you could consult an infertility specialist.  In vitro fertilization has been used successfully specifically in women with autoimmune hepatitis.  
Your first question is the most difficult and I’m not certain I can give you an answer that is satisfying.  First of all, the decision on whether it is safe for you to get pregnant is very complicated.  The physicians who advise you on this will need to know your history and you in much more detail than I do from your brief letter.  They will need to know how advanced your liver disease is and the time frame in which you are likely to need transplant.  They are also gong to need to know you and your husband well and know how important it is for you to have children and what level of risk you are willing to accept.  You should know that it is quite possible to have children after a liver transplant.  
I have reviewed the literature in great detail and I have reached the following conclusions.  There is some risk that the autoimmune hepatitis will worsen during the period in which you are pregnant.  If you have cirrhosis (your physicians should know whether you do or not), there is some potential for the autoimmune hepatitis to deteriorate in a manner that could be very harmful to you or the baby.  Having said that there are numerous reports of women with autoimmune hepatitis having successful pregnancies.  
You are going to have to sit down with your physicians and determine how advanced your liver disease is, how important it is for you and your husband to have children, how soon you are going to require transplant and whether you are better off waiting until the transplant.  If your decisions are a little uncomfortable with all of this you might want to seek an opinion from a hepatologist and fetal/maternal expert at a transplant center who have experience with this complicated situation.  
I hope this answer is helpful to you at some level. If you have additional questions or more information, feel free to post the material back to MEDHELP or you are always welcome to contact us directly at Henry Ford at [phone].  We have an active liver transplant program.  
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.