Good Maternal and Fetal Outcomes for Pregnant Women With Primary Biliary Cirrhosis

Trivedi, Palak; Kumagi, Teru; Al-Harthy, Nadya; Coltescu, Catalina; Ward, Steve; Cheung, Angela; Hirschfield, Gideon M.

doi:10.1016/j.cgh.2013.11.030

Cited by 61 publications

(55 citation statements)

References 27 publications

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“…As patients with PBC tend to present at an older age aft er the usual child-bearing age, and as women with PBC were discouraged in the past from pursuing pregnancy, there is an extremely limited number of studies on PBC and pregnancy. However, more recent studies have reported good maternal and fetal outcomes ( 144 ). PBC has been associated with disease fl are aft er delivery ( 144,145 ).…”

Section: Primary Biliary Cirrhosismentioning

confidence: 99%

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ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

231

257

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Consultation for liver disease in pregnant women is a common and oftentimes vexing clinical consultation for the gastroenterologist. The challenge lies in the need to consider the safety of both the expectant mother and the unborn fetus in the clinical management decisions. This practice guideline provides an evidence-based approach to common diagnostic and treatment challenges of liver disease in pregnant women. Am J Gastroenterol 2016; 111:176-194; doi: 10.1038/ajg.2015 Initial evaluation of pregnant patientA pregnant patient presenting with abnormal liver tests should undergo standard workup as with any non-pregnant individual (strong recommendation, very low level of evidence). Imaging in pregnancyUltrasound is safe and the preferred imaging modality used in assessment of abnormal liver tests suggestive of biliary tract disease (strong recommendation, low level of evidence).Magnetic resonance imaging without gadolinium can be used in the second and third trimester (conditional recommendation, low level of evidence).Computed tomography scans carry a risk of teratogenesis and childhood hematologic malignancies but may be used judiciously with minimized radiation protocols (2-5 rads; conditional recommendation, very low level of evidence). Endoscopy in pregnancyEndoscopy is safe in pregnancy but should be deferred until the second trimester if possible (strong recommendation, low level of evidence).Meperidine and propofol can be used for endoscopic sedation (strong recommendation, moderate level of evidence). Management of biliary disease in pregnancyERCP can be performed when indicated for pregnant women presenting with biliary disease that strongly necessitates intervention such as biliary pancreatitis, symptomatic choledocholithiasis, and/or cholangitis. Minimizing fetal exposure to fl uoroscopy is imperative (strong recommendation, low level of evidence).Symptomatic cholecystitis should be managed with early surgical intervention with laparoscopic cholecystectomy (strong recommendation, low level of evidence). Liver masses in pregnancyAsymptomatic hemangioma and focal nodular hyperplasia do not need routine imaging or surveillance during pregnancy (strong recommendation, very low level evidence).Hepatic adenomas should be monitored with ultrasound during pregnancy for growth. Patients with large adenomas (>5 cm) should be referred for resection prior to pregnancy (strong recommendation, low level of evidence). Hepatitis B in pregnancyActive-passive immunoprophylaxis with hepatitis B immunoglobulin and the HBV vaccination series should be administered to all infants born to HBV-infected mothers to prevent perinatal transmission (strong recommendation, low level of evidence).Women chronically infected with HBV and high viral load (>10 6 log copies/ml (200,000 IU/ml) and higher) should be offered antiviral medication with tenofovir or telbivudine in the third trimester to reduce perinatal transmission of HBV (strong recommendation, low level of evidence).C-section should not be performed electively in HBV-pos...

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Section: Primary Biliary Cirrhosismentioning

confidence: 99%

“…However, more recent studies have reported good maternal and fetal outcomes ( 144 ). PBC has been associated with disease fl are aft er delivery ( 144,145 ). UDCA is a pregnancy category B drug that is generally recommended for PBC ( 146 ).…”

Section: Primary Biliary Cirrhosismentioning

confidence: 99%

ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

231

257

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“…The effect of pregnancy on the cholestatic autoimmune liver diseases PBC and PSC is milder, although liver enzymes may increase temporarily in both diseases in a considerable proportion of patients after delivery [206][207][208][209]. However, maternal and fetal outcome does not seem to be impaired in mothers with PBC and PSC.…”

Section: Clinical Relevancementioning

confidence: 88%

Immunology of hepatic diseases during pregnancy

2016

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The mother's immune system has to adapt to pregnancy accepting the semi-allograft fetus and preventing harmful effects to the developing child. Aberrations in feto-maternal immune adaptation may result in disease of the mother, such as liver injury. Five pregnancy-associated liver disorders have been described so far, however, little is known concerning immune alterations promoting the respective disease. These liver disorders are pre-eclampsia, hemolysis, elevated liver enzymes, low platelet count (HELLP), acute fatty liver, hyperemesis gravidarum, and intrahepatic cholestasis of pregnancy. On the other hand, pre-existing autoimmune liver injury of the mother can be affected by pregnancy. This review intends to summarize current knowledge linking feto-maternal immunology and liver inflammation with a special emphasis on novel potential biomarkers.

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“…Some authors ascribe to the hypothalamic-pituitary axis a role in the sex steroid metabolism dysfunction in the liver [2,5,7]. Based on the present study, possible endocrine changes may be linked to the estrogen metabolism and transport.…”

Section: Discussionmentioning

confidence: 86%

“…Hepatitis is associated with increased rates of fetal morbidity and mortality [6]. When pregnancy occurs in cirrhotic patients spontaneous abortions and premature infants have been described [7].…”

Section: Introductionmentioning

confidence: 99%

Estrous Cycle, Fertilility and Fetal Development in Rats with Hyperbilirubinemia

Resende¹,

Alberti²,

Petroianu³

2017

Gynecol Obstet

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Objective: Decreasing in reproductive capacity has been observed in jaundiced female rats. The animals with hyperbilirubinemia present early sexual maturation, late ovulation, reduced number of corpora lutea and precocious vaginal opening. The interaction with toxic agents leads to abnormal development of the embryos. The objective is to investigate the influence of jaundice on estrous cycle, fertility, ovaries and fetus development.Methods: 66 female rats were divided into two groups (n=33): group 1 -ligature of the biliopancreatic duct, group 2 -sham operation. These animals were paired with males. Vaginal smears were collected daily to verify pregnancy and the gestational period. The morphologic aspect of the ovaries and the corpus luteum were studied. The morphology of the fetuses were assessed. Serum bilirubins were recorded. 32 rats of the control group and 11 jaundiced rats became pregnant. Results:The 17 rats with hyperbilirubinemia that did not become pregnant presented involutive corpora lutea and modifications in their estrous cycles, remaining in pro-estrus or estrus. The pregnant rats with hyperbilirubinemia had fetuses with abnormal development. Conclusions:Fertilization occurs in jaundiced rats, but reproductive capacity is reduced, with irregular estrous cycles, involutive corpora lutea and abnormal fetal development.

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Good Maternal and Fetal Outcomes for Pregnant Women With Primary Biliary Cirrhosis

Cited by 61 publications

References 27 publications

ACG Clinical Guideline: Liver Disease and Pregnancy

ACG Clinical Guideline: Liver Disease and Pregnancy

Immunology of hepatic diseases during pregnancy

Estrous Cycle, Fertilility and Fetal Development in Rats with Hyperbilirubinemia

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