Issue 4/2026
Yordanova. А, Hadjieva. А, Lyutakov. I, Zvezdov.D, Ivanov. K
Department of Gastroenterology, „St. Ekaterina“ Hospital – Sofia
Autoimmune liver diseases comprise a heterogeneous group of chronic, progressive, immune-mediated disorders, including autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC), characterized by hepatic inflammation, fibrosis, and the potential progression to cirrhosis. These conditions predominantly affect women of reproductive age, thereby raising important considerations in the context of pregnancy. Pregnancy is associated with immunological adaptations that generally contribute to disease stabilization; however, an increased risk of disease flare is observed in the postpartum period. In patients with AIH, maintenance therapy with corticosteroids and thiopurines is generally considered safe and may be continued during pregnancy, whereas mycophenolate mofetil is contraindicated due to its well-established teratogenic effects. In PBC, ursodeoxycholic acid (UDCA) remains the standard of care and is regarded as safe for use during both pregnancy and lactation. PSC does not appear to significantly impair fertility; however, it is associated with an elevated risk of preterm delivery and warrants careful monitoring, particularly in patients with concomitant inflammatory bowel disease. Overall, pregnancy in women with autoimmune liver diseases is feasible and is typically associated with favorable outcomes when appropriately planned, with optimal disease control and close monitoring by a multidisciplinary team. The presence of portal hypertension and its complications is associated with an increased risk of adverse maternal and fetal outcomes.
Key words: Autoimmune liver diseases, pregnancy, autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis
Adress for correspondence:
Dr. A. Yordanova
Department of Gastroenterology,
St. Ekaterina University Hospital
52, „Pencho Slaveykov“, Blvd.
1431, Sofia
Tel.: +359 895 979 456
e-mail: Aniyor13@gmail.com