autoimmune hepatitis/colitis and pregnancy

[Susan1481]

I am a 27 year old female who has autoimmune hepatitis and colitis.  I have been on imuran (azothiaprine) for about 4 years and that has held my liver enzymes in complete check and I've been fine.  I would now very much like to become pregnant, but my high-risk OBGYN has warned me of the risks of being on imuran while trying to concieve.  He has warned that there is a 1 in 7 chance that the baby will have some deformity of his/her arms, a cleft palet, and many other possible, scary abnormalities.  I am off of the drug as of now for that reason as we try to concieve.  I would very much also like to keep myself healthy, however as I understand that my health affects the health of a baby.  Is there any other medication I could take BESIDES Imuran??  I understand that Prednisone does a similar thing as Imuran (however Imuran is the best thing to treat my condition.)  Is there anything besides Prednisone?  I was on 5mg of Prednisone earlier this year (in place of Imuran), but my liver enzymes were very bad according to the lab work I had done at the time. Would a higher dose of Prednisone be an option?  Is that also harmful to a developing baby?  

Thank you for your help!!
Susan

[amileigh]

I am 24 years old and was told I would never conceive a child due to my AIH. I have had it for 12 years... I took Imuran for about 6 years along with prednisone and had to stop the imuran due to it lowering my white blood cell count to dangerously low levels so i was put on Prograf... In 2006 we concieved our first child and i was taken off the Prograf and put on Prednisone for the first half of my pregnancy and my liver enzymes were stable...i think i was on about 10 mg? Not sure cant really remember...In my 2nd half of pregnancy i stopped all meds and my enzymes stayed normal! I had a rather normal pregnancy but at 36 weeks we lost our babygirl in the womb....she was stillborn, they never found a cause so i of course blamed myself and my AIH. We just had our 2nd miracle girl and i wasnt on any meds during conception or during pregnancy and my whole pregnancy my enzymes were NORMAL! We have a beautiful 3 week old babygirl now. So a safe pregnancy is possible with AIH. I would suggest talking to your high risk OB about starting the prednisone at a slightly higher level and if you do conceive trying to wein off of it and see how your enzymes do. I know Imuran should NOT be taken during pregnancy and niether should Prograf/ Prednisone is pretty much safe during pregnancy! If you do conceive just make sure you keep all Dr appts and make sure the baby is monitored regularly and towards the end do your Kick Counts...we rented a fetal heart monitor for home in our last pregnancy and it was a god sent! www.storkradio.com! Good luck and much babydust sent your way!!!!!

[mikesimon]

"Autoimmune Hepatitis and Pregnancy

In many cases, severe autoimmune hepatitis (AIH; discussed in Chapter 14) causes women to stop menstruating, and as a result, these women cannot become pregnant. However, when treated with corticosteroids and azathioprine, menstrual cycles usually return to normal and pregnancy can be achieved. Women with AIH generally have successful pregnancies and deliveries.

Flare-ups of AIH may occur during pregnancy, although such occurrences are usually rare due to the immunosuppressive effects of pregnancy. In fact, some women have even experienced a remission of AIH during pregnancy. To further minimize the chance of an AIH flare-up, a pregnant woman should remain on therapy during pregnancy. At low dosages, both prednisone and azathioprine have been demonstrated to be safe for use during pregnancy. However, as a precaution, it is probably wise to discontinue using azathioprine as soon as pregnancy is discovered as some studies have found this medication to be teratogenic. Furthermore, if contemplating pregnancy, one should probably discontinue azathioprine approximately six months before conceiving. Urodeoxycholic acid and cholestyramine, two other medications often used in the treatment of AIH are considered safe during pregnancy. For women with AIH, there are a few instances in which pregnancy should be delayed at least one year because a poor outcome is likely. These situations include an AIH flare-up, any liver-related complication, such as variceal bleeding, or the recent withdrawal of prednisone.

Although rare, stillbirths and premature labor have been reported among women with AIH. Conservative management during pregnancy, which should include fluid and sodium restriction and the elimination of all unnecessary medications, enhances the likelihood of a successful outcome for both the mother and her unborn baby."

See: http://www.liverdisease.com/pregnancy.html


Pregnancy outcome of women exposed to azathioprine during pregnancy.
Goldstein LH, Dolinsky et al.

Clinical Pharmacology Unit, Teratogen Information Service, Assaf Harofeh Medical Center, Sackler School of Medicine, Tel Aviv University, Israel.

"BACKGROUND: Azathioprine (AZP) interferes with nucleic acid synthesis and is teratogenic in animals. In view of the paucity of information on the use of AZP during pregnancy we investigated this subject in a prospective, controlled, multicenter study. Our objective was too determine whether exposure to AZP during pregnancy increases the risk for major malformations and to determine the effect on pregnancy outcome. METHODS: Pregnant women on AZP who contacted one of seven teratogen information services were compared to a cohort of pregnant women who contacted two of the seven teratogen information services and took nonteratogenic treatments during their pregnancy. RESULTS: Follow-up was completed on 189 women in the AZP group and compared to 230 women in the control group. The rate of major malformations did not differ between groups with six neonates in each; the AZP rate was 3.5% and the control group rate was 3.0% (p = .775; OR 1.17; CI: 0.37, 3.69). The mean birth weight and gestational age were lower in the AZP group (2,995 g vs. 3,252 g [p = .001, difference of mean: 257, 95% CI: 106.3, 408.1] and 37.8 weeks vs. 39.1 weeks [p = .001, difference of mean: 1.3, 95% CI: .5, 2.0], respectively). The AZP group had more cases of prematurity (21.4% vs. 5.2% [p < .001; OR 4.0; 95% CI: 2.0, 8.06]) and low birth weight (23% vs. 6.0% [p < .001; OR 3.81; 95% CI: 2.0, 7.2]). CONCLUSIONS: These results suggest that AZP (50-100 mg/day) does not triple the rate of birth defects; however, it is associated with lower birth weight, gestational age, and prematurity. Larger studies are needed to confirm these observations."

See:  http://tinyurl.com/5yrtmy