Gestational Alloimmune Liver Disease

Anastasio, Hannah; Grundy, Maureen; Birsner, Meredith L.

doi:10.1097/aog.0000000000001569

Cited by 5 publications

(3 citation statements)

References 7 publications

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“…So far, There is no gold diagnostic tool for GALD. Despite the most common presentation benign neonatal hemochromatosis, extrahepatic siderosis is not found in up to 40% of cases of gestational alloimmune hepatopathy, as it was revealed in our case, demonstrating the spectrum of disease phenotypes (1).…”

Section: Discussionmentioning

confidence: 39%

“…In addition, once a woman has delivered an infant with GALD, the probability that the next pregnancy will be affected is greater than 90%. Recurrence can however be prevented by treatment with IVIG during pregnancy (1,24).…”

Section: Discussionmentioning

confidence: 99%

“…Gestational alloimmune liver disease is a rare and serious condition caused by a maternal-fetal alloimmune disorder, which occurs antenatally and leads to severe fetal liver failure with possible neonatal hemochromatosis (1).…”

Section: Introductionmentioning

confidence: 99%

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GALD: new diagnostic tip for early diagnosis - a case report and literature review

Zermano

Novak

Vogrig

et al. 2023

Front. Reprod. Health

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ObjectiveGestational alloimmune liver disease is a rare and serious condition caused by a maternal-fetal alloimmune disorder. There are not many studies about the antenatal treatment (IVIG infusion) of affected fetuses as the diagnosis is generally made postnatally. The possibility of an early diagnosis by means of ultrasonography and a gynecologist's assesment can provide prompt treatment of this disease.Case reportWe report the case of 38-year-old pregnant woman referred to our centre in view of severe fetal hydrops seen by ultrasound at 31 weeks + 1 day gestation. A male infant was born and subsequently died after developing liver failure. Postmortem examination revealed the presence of diffuse hepatic fibrosis in the absence of hemosiderin deposits and no extrahepatic siderosis. Immunohistochemical analysis was also performed which showed diffuse hepatocyte positivity for the terminal complement complex (C5b-C9) confirming the suspicion of GALD.MethodsA comprehensive literature search published from 2000 to 2022 was conducted on PubMed and Scopus. Paper selection was performed following the PRISMA guidelines. Fifteen retrospective studies were identified and selected.ResultsA total of 15 manuscripts describing 26 cases were finally included in our research. Twenty-two fetuses/newborns with suspected GALD were studied, of which 11 had a confirmed histopathological diagnosis of GALD. Prenatal diagnosis of gestational alloimmune liver disease is difficult because ultrasound findings may be absent or nonspecific. Only one case report described fetal hydrops similar to our clinical case. As highlighted by the current case, in fetuses presenting with hydrops, once the most common etiologies have been excluded, hepatobiliary complications and liver failure caused by GALD should be consideredConclusionsGlobal knowledge of this disorder and its wide spectrum of presentations may help to increase the number of cases that are diagnosed early and accurately. The recurrence rate of an infant being affected with GALD in another pregnancy is more that 90%. Recurrence however can be prevented by treatment with IVIG during pregnancy. This highlights the importance of having obstetricians and pediatricians familiar with gestational alloimmune liver disease.

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Section: Discussionmentioning

confidence: 39%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

GALD: new diagnostic tip for early diagnosis - a case report and literature review

Zermano

Novak

Vogrig

et al. 2023

Front. Reprod. Health

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Expanding the spectrum of gestational alloimmune liver disease

Ketteridge

Moore

2021

J Paediatrics Child Health

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Antenatal Treatment with Intravenous Immunoglobulin to Prevent Gestational Alloimmune Liver Disease: Comparative Effectiveness of 14-Week versus 18-Week Initiation

et al. 2017

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Background: Antenatal therapy with high-dose intravenous immunoglobulin (IVIG) may prevent gestational alloimmune liver disease (GALD). Objective: The objective of this study was to determine the effectiveness of this approach in a large cohort of women at risk for poor pregnancy outcome due to GALD. Methods: Women with a history of affected offspring were provided antenatal IVIG treatment and data were acquired prospectively from 1997 to 2015. The outcomes of treated pregnancies were compared to those of untreated pregnancies, and the effectiveness of starting at 14 weeks was compared to that of starting at 18 weeks. Results: A total of 188 treated pregnancies in 151 women were analyzed. Only 30% (n = 105) of untreated gestations resulted in healthy offspring as compared to 94% (n = 177) of treated pregnancies (p < 0.0001). Treated gestations of both the 14-week (n = 108) and the 18-week (n = 80) start cohort showed a decreased rate of fetal loss relative to untreated gestations (p < 0.0001). Equivalent outcomes were recorded in the 18-week versus the 14-week start cohort (p > 0.05). Few adverse events or complications of antenatal therapy were recorded. Conclusion: Antenatal therapy with high-dose IVIG initiated at either 18 or 14 gestational weeks effectively prevents poor outcome of pregnancies at risk for GALD.

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Gestational Alloimmune Liver Disease

Abstract: Recognition of gestational alloimmune liver disease enables antepartum treatment that dramatically alters the course of disease.

Cited by 5 publications

References 7 publications

GALD: new diagnostic tip for early diagnosis - a case report and literature review

GALD: new diagnostic tip for early diagnosis - a case report and literature review

Expanding the spectrum of gestational alloimmune liver disease

Antenatal Treatment with Intravenous Immunoglobulin to Prevent Gestational Alloimmune Liver Disease: Comparative Effectiveness of 14-Week versus 18-Week Initiation

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