Gestational Alloimmune Liver Disease in Cases of Fetal Death

Whitington, Peter F.; Pan, Xiaomin; Kelly, Susan; Melín-Aldana, Héctor; Malladi, Padmini

doi:10.1016/j.jpeds.2011.03.048

Cited by 44 publications

(44 citation statements)

References 13 publications

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“…18 The livers from these infants demonstrate hepatocyte necrosis without collapse, fibrosis or inflammation indicating a hyperacute process. There may not be any siderosis in the liver or other tissues.…”

Section: Liver Pathologymentioning

confidence: 93%

Neonatal Hemochromatosis

Feldman

Whitington

2013

Journal of Clinical and Experimental Hepatology

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102

116

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Section: Liver Pathologymentioning

confidence: 93%

Neonatal Hemochromatosis

Feldman

Whitington

2013

Journal of Clinical and Experimental Hepatology

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102

116

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“…Many fetal losses occurred after 18 weeks in untreated pregnancies and thus were considered to be very likely due to GALD. However, nearly twice as many occurred before 18 weeks, the earliest gestational age at which a confirmed case of GALD has been identified [9]. The elimination of spontaneous abortions at <18 weeks in treated pregnancies suggests that GALD may have been the root cause of many of the spontaneous abortions that occurred before 18 weeks.…”

Section: Discussionmentioning

confidence: 99%

“…GALD is the dominant cause of neonatal liver failure [8]. In addition, GALD can cause fetal death due to liver failure, with or without fetal hemochromatosis [9]. The incidence of GALD and GALD-related NH is unknown, but it is considered to be rare.…”

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confidence: 99%

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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“…La reciente demostración de aloinmunidad materna capaz de causar enfermedad hepática fetal en etapas precoces del embarazo, aun sin acumulación de Fe, obliga a replantearse la verdadera frecuencia de esta entidad, y constituye un desafío inmediato para todos aquellos involucrados en el cuidado de la madre y el niño recién nacido. 33 …”

Section: El Futurounclassified

El nuevo paradigma de la hemocromatosis neonatal: hepatitis fetal aloinmunitaria

Costaguta

Álvarez

2012

Arch Argent Pediat

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Arch Argent Pediatr 2012;110(3):237-243 / 237 RESUMEN El modelo clásico de la hemocromatosis neonatal contemplaba la analogía con la hemocromatosis hereditaria. El tratamiento médico se basaba en un cóctel quelante/antioxidante. La hipótesis actual de un origen aloinmunitario del proceso, en el que la madre gestante monta una respuesta destructiva de tipo IgG contra los hepatocitos fetales, ha ofrecido una mejor explicación fisiopatológica y permite enfocar el tratamiento en el aspecto inmunológico con excelentes resultados, incluso previniendo la enfermedad en embarazos posteriores. Este cambio de paradigma repercute profundamente en el diagnóstico, pronóstico y tratamiento de la enfermedad, que debería denominarse "hepatitis fetal aloinmunitaria". Palabras clave: hemocromatosis, neonatal, hepatitis, aloinmunitaria. SUMMARYThe classical model of neonatal hemochromatosis was based on the analogy with hereditary hemochromatosis. Medical treatment consisted on the antioxidant-chelator cocktail. The new hypothesis of an alloimmune origin of the process by which the pregnant woman mounts an IgG-based destructive response against fetal hepatocytes offers a pathogenic explanation, allowing treatment to be focused on the immunological aspects, with excellent results, and opens the possibility of preventive treatment in future pregnancies. This new paradigm produces a deep impact in diagnosis, prognosis and treatment of the disease, that should be called "fetal alloimmune hepatitis".

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Gestational Alloimmune Liver Disease in Cases of Fetal Death

Cited by 44 publications

References 13 publications

Neonatal Hemochromatosis

Neonatal Hemochromatosis

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

El nuevo paradigma de la hemocromatosis neonatal: hepatitis fetal aloinmunitaria

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