A 44-year-old woman with autoimmune hepatitis is in remission on azathioprine 1.5 mg/kg/day. She wishes to conceive. What is the safest approach?

• A Discontinue all immunosuppression 3 months before conception
• B Switch to mycophenolate mofetil for more effective maintenance
• C Restart prednisolone as monotherapy and stop azathioprine
• D Continue azathioprine; it is safe in pregnancy ✓

Explanation

Azathioprine is considered safe during pregnancy — decades of data in IBD and transplant patients show no significant teratogenicity at standard doses. Stopping immunosuppression risks AIH flare during pregnancy or postpartum. Mycophenolate mofetil is absolutely contraindicated in pregnancy (category X; major teratogen — causing cardiac, ear, and limb malformations). Prednisolone monotherapy is an option but is not superior to continuing azathioprine, which maintains effective AIH control with a safe pregnancy profile.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.