Liver Disease During Pregnancy: A Challenging Clinical Issue

Mikolašević, Ivana; Filipec-Kanižaj, Tajana; Jakopčić, Ivan; Majurec, Iva; Brnčić–Fischer, Alemka; Sobočan, Nikola; Hrstić, Irena; Štimac, Tea; Štimac, Davor; Milić, Sandra

doi:10.12659/msm.907723

Cited by 87 publications

(103 citation statements)

References 89 publications

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“…The benefits of liver transplantation for HBV-ACLF may not be as great as expected. Thus far, most published studies have focused on pregnancies after liver transplantation [12]. Liver transplantation in pregnant women may involve more challenges.…”

Section: Discussionmentioning

confidence: 99%

Acute-on-Chronic Liver Failure in Pregnant Patients with Chronic Hepatitis B: A Retrospective Observational Case Series Study

Wang

Xiong

Luo

et al. 2020

Gastroenterology Research and Practice

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Background and Aims. Acute-on-chronic liver failure (ACLF) is common in patients with end-stage liver disease and chronic hepatitis B (CHB) or hepatitis B virus- (HBV-) related cirrhosis. To date, no uniform definition and management strategy are available for ACLF. Although a considerable number of studies on ACLF has been published, there are few reports on ACLF in pregnant women with CHB. This study retrospectively reviewed five patients who were diagnosed with ACLF during pregnancy in the past 10 years. We aimed at investigating their clinical characteristics, treatment, biochemical test results, and maternal and fetal outcomes. Results. Asthenia, anorexia, and jaundice were the main initial clinical manifestations in these patients during the second or third trimester of pregnancy. All patients received antiviral therapy. None of the pregnant women died after treatment. Patient #4 was treated with an artificial liver support system, and patients #2 and #5 underwent transfusion therapy. The acute insult in all patients was HBV DNA reactivation. Except for patient #3, who chose an actively induced vaginal delivery because of intrauterine fetal demise, the remaining four patients underwent a preterm delivery via a cesarean section. The four neonates were alive, although all were small for gestational age. Conclusion. Asthenia, anorexia, and jaundice during mid-late pregnancy should be immediately investigated. Before and during the pregnancy, hepatologists or obstetricians should actively screen pregnant women with CHB for HBV DNA status and alanine aminotransferase levels. Reactivation of HBV replication in pregnant women with CHB may lead to ACLF, especially in multiparous women. Once ACLF is diagnosed, antiviral therapy should be considered as soon as possible to protect maternal and fetal health.

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Section: Discussionmentioning

confidence: 99%

Acute-on-Chronic Liver Failure in Pregnant Patients with Chronic Hepatitis B: A Retrospective Observational Case Series Study

Wang

Xiong

Luo

et al. 2020

Gastroenterology Research and Practice

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“…The perturbations of LFT in HG have no clinical impact on the hepatic functioning. The synthetic function remains intact, as evidenced by the absence of an effect on the coagulation profile and serum albumin levels, except when malnutrition occurs [13]. In an unusual case reported by Larrey et al, the patient developed HG in three consecutive pregnancies [20].…”

Section: Discussionmentioning

confidence: 94%

“…It does not reveal any changes in the liver size, parenchymal echotexture or the biliary radicles. Any changes observed can be ascribed to other disorders rather than HG [13]. Liver biopsy is hardly ever indicated, but may be necessary when diagnosis is doubtful and atypical pattern of LFT is seen.…”

Section: Discussionmentioning

confidence: 99%

Study of Liver Dysfunction in Hyperemesis Gravidarum

Gaba

2020

Cureus

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Introduction Hyperemesis gravidarum (HG) is said to occur when early pregnancy is complicated by excessive vomiting that leads to electrolyte imbalance, ketosis or loss of more than 5% of the bodyweight. It can be accompanied by deranged liver function tests (LFT), and most patients recover uneventfully with no fetal harm. Methods A retrospective study was conducted by evaluating records of 135 patients who were admitted or underwent day care for HG at our center over a period of 30 months. After excluding patients who were not investigated and those with another pre-existing or newly diagnosed liver disease, 63 patients were enrolled in the study. Their LFT were analyzed with the software Graphpad Prism version 8.4 (GraphPad Software, San Diego, California). The values were expressed as mean ± standard deviation and statistical analysis was done using unpaired t test and simple linear regression. Results The mean age of the study population was 26.59 ± 5.15 years and the mean period of gestation was 13.27 ± 2.48 weeks. 60.3% (38/63) of the patients had some form of abnormality on the LFT. The mean total serum bilirubin (TSB) was 1.56 ± 0.84 mg/dL, mean aspartate transaminase (AST) was 46.63 ± 30.89 U/L and mean alanine transaminase (ALT) was 51.35 ± 42.86 U/L. ALT was higher than AST with statistical significance (p<0.0001). There was no statistically significant difference in the LFT of primigravida and multigravida women. The study population included three diabetic and two hypertensive women, and two women had multiple pregnancy. All the patients were treated with anti-emetics. One patient required corticosteroid administration, and none required termination of pregnancy. Conclusion Mild liver dysfunction in HG can occur in over 50% of the patients. When diagnosis is not in doubt, no further intervention is required with regard to the LFT.

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“…The previous study reported that nearly 3% of pregnancies are complicated by a variety of liver disease, which can have fatal consequences for pregnant women and offspring 39 . More notably, Hepatitis B is high-endemic in China.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a prediction model on severe maternal outcomes among pregnant women with pre-eclampsia: a 10-year cohort study

Tan

Yang

Liao

et al. 2020

Sci Rep

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Pre-eclampsia is a severe hypertensive disorder of pregnancy and could lead to severe maternal morbidities and death. Our study aimed to develop and validate a prognostic prediction model for severe maternal outcomes among Chinese population with pre-eclampsia. We conducted a 10-year cohort study in a referral center by collecting all pregnant women who diagnosed as pre-eclampsia and delivered from 2005 to 2014. A composite of severe maternal outcomes, including maternal near-miss defined by World Health Organization, cortical blindness/retinal detachment, temporary facial paralysis and maternal death, were adopted. We used logistic regression model to develop Model 1 by retaining the predictors of p < 0.05, and further conducted Model 2 by adding quadratic terms and interaction terms to Model 1. We undertook a bootstrapping validation and estimated the model performance. A total of 397 pregnant women suffered from severe maternal outcomes among 2,793 eligible participants, with an incidence of 14.21% (95% confidence interval (CI) 12.91%–15.51%). Of 13 predictors were finally selected in Model 1. Combined with quadratic and interactive terms, the Model 2 showed higher area under the ROC curve (82.2%, 95% CI 79.6%–84.7%) and good calibration. By the bootstrapping validation, similar model performances were present.

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Liver Disease During Pregnancy: A Challenging Clinical Issue

Cited by 87 publications

References 89 publications

Acute-on-Chronic Liver Failure in Pregnant Patients with Chronic Hepatitis B: A Retrospective Observational Case Series Study

Acute-on-Chronic Liver Failure in Pregnant Patients with Chronic Hepatitis B: A Retrospective Observational Case Series Study

Study of Liver Dysfunction in Hyperemesis Gravidarum

Development and validation of a prediction model on severe maternal outcomes among pregnant women with pre-eclampsia: a 10-year cohort study

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