Recent trends in hepatic diseases during pregnancy in the United States, 2002–2010

Ellington, Sascha; Flowers, Lisa; Legardy-Williams, Jennifer; Jamieson, Denise J.; Kourtis, Athena P.

doi:10.1016/j.ajog.2014.10.1093

Cited by 44 publications

(30 citation statements)

References 17 publications

(27 reference statements)

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“…This referral bias (Berkson bias) has been identified previously for many conditions 28 . In addition, the lack of specific diagnosis codes for each of the LDoP conditions limits the accuracy of studies derived from administrative data 29 , which use the broad diagnosis code of “liver diseases of pregnancy” (ICD-9 code 646.7) and may include other hepatobiliary conditions which are not unique to pregnancy. Indeed, by manual review of their medical records, we excluded a large number of subjects with abnormal liver tests during pregnancy (47 out of 294), due to acute biliary conditions and chronic hepatitis which were captured under ICD-9 codes used for liver diseases unique to pregnancy.…”

Section: Discussionmentioning

confidence: 99%

The Epidemiology of Liver Diseases Unique to Pregnancy in a US Community: A Population-Based Study

Allen

Kim

Larson

et al. 2016

Clinical Gastroenterology and Hepatology

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Background & Aims Little is known in the United States (US) about the epidemiology of liver diseases that develop only during (are unique to) pregnancy. We investigated the incidence of liver diseases unique to pregnancy in Olmsted County, MN and long-term maternal and fetal outcomes. Methods We identified 247 women with liver diseases unique to pregnancy from 1996 through 2010 using the Rochester Epidemiology Project database. The crude incidence rate was calculated by the number of liver disease cases divided by 35,101 pregnancies. Results Of pregnant women with liver diseases, 134 had preeclampsia with liver dysfunction, 72 had hemolysis-associated increased levels of liver enzymes and low-platelet (HELLP) syndrome, 26 had intrahepatic cholestasis of pregnancy, 14 had hyperemesis gravidarum with abnormal liver enzymes, and 1 had acute fatty liver of pregnancy. The crude incidence of liver diseases unique to pregnancy was 0.77%. Outcomes were worse among women with HELLP or preeclampsia than the other disorders—of women with HELLP, 70% had a premature delivery, 4% had abruptio placentae, 3% had acute kidney injury, and 3% had infant death. Of women with preeclampsia, 56.0% had a premature delivery, 4% had abruptio placentae, 3% had acute kidney injury, and 0.7% had infant death. After 7 median years of follow up (range, 0–18 years), 14% of the women developed recurrent liver disease unique to pregnancy; the proportions were highest in women with initial hyperemesis gravidarum (36%) or intrahepatic cholestasis of pregnancy (35%). Women with preeclampsia were more likely to develop subsequent hepatobiliary diseases. Conclusion We found the incidence of liver disease unique to pregnancy in Olmsted County, MN to be lower than that reported from Europe or US tertiary referral centers. Maternal and fetal outcomes in Olmsted County were better than those reported from other studies, but fetal mortality was still high (0.7%–3.0%). Women with preeclampsia or HELLP are at higher risk for peri-partum complications and subsequent development of comorbidities.

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Section: Discussionmentioning

confidence: 99%

The Epidemiology of Liver Diseases Unique to Pregnancy in a US Community: A Population-Based Study

Allen

Kim

Larson

et al. 2016

Clinical Gastroenterology and Hepatology

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“…5–10 Whether the prevalence of these conditions has stabilized, decreased, or worsened since these reports is largely unknown. There is also a paucity of information on how the prevalence of chronic conditions varies by key socio-economic predictors of obstetric morbidity and mortality, including rural vs. urban residence, 11 income, 4,12 and insurance coverage status.…”

Section: Introductionmentioning

confidence: 99%

Disparities in Chronic Conditions Among Women Hospitalized for Delivery in the United States, 2005–2014

Admon

Winkelman

Moniz

et al. 2017

Obstetrics &Amp; Gynecology

148

112

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Objective To estimate trends in the prevalence and socio-economic distribution of chronic conditions among women hospitalized for obstetric delivery in the United States. Methods A retrospective, serial cross-sectional analysis was conducted using 2005 to 2014 data from the National Inpatient Sample. We estimated the prevalence of eight common, chronic conditions, each associated with obstetric morbidity and mortality, among all childbearing women and then across socio-economic predictors of obstetric outcomes. Differences over time were measured and compared across rural vs. urban residence, income, and payer subgroups for each condition. Results We identified 8,193,707 delivery hospitalizations, representing 39,273,417 delivery hospitalizations occurring nationally between 2005 and 2014. Identification of at least one chronic condition increased significantly between 2005–2006 and 2013–2014 (66.9 per 1,000 delivery hospitalizations in 2005–2006 vs. 91.8 per 1,000 delivery hospitalizations in 2014–2015). The prevalence of multiple chronic conditions also increased during the study period, from 4.7 (95% CI 4.2–5.2) to 8.1 (95% CI 7.8–8.4) per 1,000 delivery hospitalizations between 2005–2006 and 2013–2014. Chronic respiratory disease, chronic hypertension, substance use disorders, and pre-existing diabetes were the disorders with the greatest increases in prevalence over time Increasing disparities over time were identified across all socio-economic subgroups analyzed including rural vs. urban residence, income, and payer. Key areas of concern include the rate at which substance use disorders rose among rural women and the disproportionate burden of each condition among women from the lowest income communities and among women with Medicaid as their primary payer. Conclusion From 2005–2006 through 2013–2014, the prevalence of chronic conditions increased across all segments of the childbearing population. Widening disparities were identified over time, with key areas of concern including disproportionate, progressive increases in the burden of chronic conditions among women from rural and low income communities and those with deliveries funded by Medicaid.

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“…Injection drug use of opioids and heroin has increased in association with the prescription opioid epidemic as people have transitioned to injecting opioids and heroin after initiating prescription opioid use (Becker, Sullivan, Tetrault, Desai, & Fiellin, 2008; Grau et al, 2007; Muhuri, Gfroerer, & Davies), with concomitant increases in hepatitis C virus (HCV) infection (Suryaprasad et al, 2014). Two studies have estimated that between 10–17 of 100,000 pregnant women are chronically infected with HCV (Ellington, Flowers, Legardy-Williams, Jamieson, & Kourtis, 2015; Salihu et al, 2012). However, a recent retrospective study of inpatient pregnancies in the U.S. between 1998 and 2011, showed that HCV rates per 100,000 deliveries increased by over 5-fold, from 42 to 210 in those years, respectively (Salemi et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Hepatitis C Cascade of Care Among Pregnant Women on Opioid Agonist Pharmacotherapy Attending a Comprehensive Prenatal Program

Page

Leeman

Bishop

et al. 2017

Matern Child Health J

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Background Given the large increases in opioid use among pregnant women and associations with hepatitis C virus (HCV) infection, screening pregnant women who are on (opioid agonist) pharmacotherapy for HCV infection has potential to inform medical care for these mothers as well as their newborns. We investigated the HCV testing cascade among pregnant women on pharmacotherapy in order to describe exposure and infection rates and to identify opportunities that would improve care. Methods Secondary analyses of laboratory results were performed for HCV testing, including anti-HCV, viremia (RNA) and genotype. Information was abstracted from the medical records of women who were followed at a comprehensive prenatal care clinic for women with substance use disorders at the University of New Mexico. Results The sample included 190 pregnant women, of whom 188 were on pharmacotherapy (43.7% on buprenorphine and 55.3% on methadone); the remaining two had tested positive for heroin or prescription opioids. A total of 178 (93.7%) were tested for anti-HCV, 94 (98.9%) of whom were tested for RNA, and 41 (57.7%) were genotyped. Prevalence of exposure to HCV by anti-HCV results was 53.3%, and 37.3% were positive for HCV RNA indicating chronic infection. Conclusions The high prevalence of exposure and infection with HCV in pregnant women who involved in pharmacotherapy for a substance use disorder indicate a need for ongoing surveillance and testing for HCV. Identifying HCV during pregnancy is crucial because this identification would serve to enhance medical care and potentially prevent vertical transmission. Identifying HCS would also facilitate referrals to newly available curative HCV treatments following delivery.

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Recent trends in hepatic diseases during pregnancy in the United States, 2002–2010

Cited by 44 publications

References 17 publications

The Epidemiology of Liver Diseases Unique to Pregnancy in a US Community: A Population-Based Study

The Epidemiology of Liver Diseases Unique to Pregnancy in a US Community: A Population-Based Study

Disparities in Chronic Conditions Among Women Hospitalized for Delivery in the United States, 2005–2014

Hepatitis C Cascade of Care Among Pregnant Women on Opioid Agonist Pharmacotherapy Attending a Comprehensive Prenatal Program

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