Clinical and obstetrical management of pregnant women with autoimmune hepatitis complicated by moderate or severe thrombocytopenia

Nomura, Roseli Mieko Yamamoto; Kleine, Rodolpho Truffa; Igai, Ana Maria Kondo; Francisco, RoRossana Pulcineli Vieira; Zugaib, Marcelo

doi:10.1016/s2255-4823(13)70426-0

Cited by 3 publications

(4 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[ 10,11,49 ] Previous nationwide population studies and single center studies have reported average rates of 20%, though one study reported rates as low as 6% (2/35 pregnancies). [ 10–12,15,27,29 ] A more recent US‐based population study reported that AIH was associated with preterm birth when compared with women without CLD (9% AIH vs. 5% no CLD, p = 0.01); however, when AIH was compared with CLD of other etiologies, there was no statistically significant difference in preterm births (9% AIH vs. 7% CLD, p = 0.39). This may suggest the risk of preterm birth could be related to AIH being a CLD rather than specifically due to AIH.…”

Section: Management Of Patients With Established Aih In Pregnancymentioning

confidence: 99%

“…This is reflected in the higher rate of LOBR in the postpartum with average rates of approximately 50% (Figure 1). [11,14,15]…”

Section: Pregnancy and The Immune System: Impact On Aihmentioning

confidence: 99%

“…The previous single center studies have reported higher Cesarean section (CS) rates in AIH, especially in the presence of cirrhosis (11/43 cirrhosis vs. 6/57 noncirrhosis, p = 0.047). [10,12,15] However, the more recent population studies have not demonstrated an increased rate of CS in AIH. [4,51] This may be due to selection bias of single centers with higher proportion of advanced liver disease compared with populationbased studies.…”

Section: Mode Of Deliverymentioning

confidence: 99%

“…[11,47] The reported rates of intrapartum LOBR are largely derived from single centers and range between 0% and 35%. [15,54] In comparison, the patients with AIH who are not pregnant have an LOBR of 42% and a relapse rate of 47%-87% on treatment withdrawal. [55,56] In an early single center study from King's College Hospital, four cases (12.5%) of intrapartum LOBR were described.…”

Section: Management Of Unstable Aih In Pregnancymentioning

confidence: 99%

See 3 more Smart Citations

Autoimmune hepatitis in pregnancy: Pearls and pitfalls

Chung

Heneghan

2022

Hepatology

View full text Add to dashboard Cite

Autoimmune hepatitis (AIH) in pregnancy has many unique considerations.Evidence provided from single center studies with patient level data and nationwide population studies provide valuable insight into this complex situation. Because a planned pregnancy is a safer pregnancy, preconception counseling is a crucial opportunity to optimize care and risk stratify women with AIH. Women with chronic liver disease who receive preconception advice and counseling are more likely to achieve stable liver disease at conception and undergo appropriate variceal surveillance. Loss of biochemical response in pregnancy is associated with adverse outcomes in unstable disease. New onset AIH in pregnancy should be managed with classical treatment regimens. The continued use of immunosuppression in pregnancy, with the exception of mycophenolate mofetil, has not shown to adversely affect the rates of stillbirth or congenital malformation. Previously adopted immunosuppression withdrawal paradigms in pregnancy should no longer be considered advantageous, because remission loss postdelivery is likely (12%-86%). Population studies, report improved outcomes with preterm birth rates falling from 20% to 9%-13% in AIH pregnancies over a 20-year period.Newer data have also demonstrated an increased risk of gestational diabetes and hypertensive complications in AIH pregnancy, which has implications for management and preeclampsia prevention with aspirin use. This review aims to provide the framework to guide and manage pregnancy in AIH outlining pearls and pitfalls to ensure optimal outcomes for mother, baby and to reduce variation in practice.

show abstract

Section: Management Of Patients With Established Aih In Pregnancymentioning

confidence: 99%

“…This is reflected in the higher rate of LOBR in the postpartum with average rates of approximately 50% (Figure 1). [11,14,15]…”

Section: Pregnancy and The Immune System: Impact On Aihmentioning

confidence: 99%

Section: Mode Of Deliverymentioning

confidence: 99%

Section: Management Of Unstable Aih In Pregnancymentioning

confidence: 99%

See 2 more Smart Citations

Autoimmune hepatitis in pregnancy: Pearls and pitfalls

Chung

Heneghan

2022

Hepatology

View full text Add to dashboard Cite

show abstract

Systematic review with meta‐analysis: outcomes of pregnancy in patients with autoimmune hepatitis

Huang

Hegarty

et al. 2022

Aliment Pharmacol Ther

View full text Add to dashboard Cite

show abstract

Acute Hepatitis in Pregnancy: A Case Report

Amp¹,

Act²,

Apxp³

et al. 2020

Asp Biomed Clin Case Rep

View full text Add to dashboard Cite

Introduction: Several changes occur in women’s body during pregnancy, as well as several pathologies can arise at this period, such as hepatitis. It is very important to have the correct diagnosis and proper treatment for pregnant women because liver diseases can increase maternal and/or fetal morbidity and mortality rates. Case Report: Patient in the age group 32 years, G2P0A1, thrombophilic, using ASA, enoxaparin, folate, and B-complex, reported jaundice, low fever, and pruritus in the 32nd week of pregnancy. Laboratory exams showed high levels of direct hyperbilirubinemia and aminotransferases, with negative serology results for the most common viruses and autoimmunity markers. Hypervitaminosis B12 was an additional finding; it was canceled. The patient had a satisfactory recovery after support treatment. Discussion: Hepatitis has several etiologies; it is caused by infections, medications, or triggered by the immune system. The main infectious agents causing hepatitis A, B, C, and E; Dengue, Zika, HTLV, cytomegalovirus, toxoplasmosis, rubella, and brucellosis were screened in the reported case – the patient was negative for all of them. Other possible diagnoses, such as acute liver steatosis of pregnancy, portal thrombosis, and autoimmune hepatitis were excluded. Hepatitis caused by medicines was not confirmed because clinical and laboratory exams showed improvement in the patient’s clinical condition even with ASA and enoxaparin administration. The patient had high vitamin B12 level, which can be a liver damage marker. Transaminases and bilirubin showed a progressive decrease after the treatment; both patient and newborn had a satisfactory recovery. The reported condition was caused by a combination of factors, such as pregnancy hormone levels, unidentified infection, and possible predisposition to develop the disease. The patient remains under hematological and hepatological follow up, but there is no record of relapse, so far.

show abstract

Clinical and obstetrical management of pregnant women with autoimmune hepatitis complicated by moderate or severe thrombocytopenia

Cited by 3 publications

References 16 publications

Autoimmune hepatitis in pregnancy: Pearls and pitfalls

Autoimmune hepatitis in pregnancy: Pearls and pitfalls

Systematic review with meta‐analysis: outcomes of pregnancy in patients with autoimmune hepatitis

Acute Hepatitis in Pregnancy: A Case Report

Contact Info

Product

Resources

About