Liver disease in pregnancy

Sasamori, Yukifumi; Tanaka, Atsushi; Ayabe, Tokiyoshi

doi:10.1111/hepr.13540

Cited by 20 publications

(24 citation statements)

References 61 publications

(78 reference statements)

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“…When levels reach 100 mmol/L, the risk of adverse fetal outcomes is increased further, with a 3.44% risk of stillbirth [12]. Although the diagnostic criteria are focused on bile acid levels, other liver function parameters such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), and bilirubin are used to obtain a fuller picture and to rule out cases in which other liver diseases are present [13].…”

Section: Introductionmentioning

confidence: 99%

Intrahepatic Cholestasis of Pregnancy: Role of Baby’s Sex on Itch Severity and Bile Acid Levels

Bartolone¹,

Mayrovitz²

2021

Cureus

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Background Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disorder of pregnancy. It occurs when bile flow from the liver is obstructed, causing bile acid to accumulate. ICP usually presents with itching that lasts for the remainder of pregnancy. Untreated ICP has been shown to increase the incidence of adverse outcomes for the baby, including respiratory distress, meconium aspiration, neonatal intensive care unit hospitalization, and stillbirth. The probability of these events increases when bile acid levels are greater than 40 mmol/L. The current standard of care for ICP patients is a combination of ursodeoxycholic acid by mouth and early delivery, as the risk of stillbirth due to ICP increases in the last weeks of pregnancy. ICP has been linked to preeclampsia and gestational diabetes; studies have shown that the occurrence of both diseases is greater when the baby is male. The purpose of this study was to investigate if the occurrence, timing of diagnosis, peak bile acid levels, or severity of itching is dependent on the baby's sex in mothers who had ICP. Methods An online question-set (survey) was offered to women who had had ICP and were members of three different online support groups. Results A total of 1,502 women responded for a total of 2,289 documented ICP pregnancies, in which there were 1,059 female babies and 1,230 male babies. Based on chi-square analysis of differences in frequencies, no difference was found between pregnancies with male versus female babies regarding the occurrence, timing of diagnosis, peak bile acid levels, or severity of itching in the evaluated population. However, surprisingly, the findings revealed that first-trimester diagnosis of ICP was made in 5.6% of the pregnancies, and there were 30 (1.8%) cases of ICP diagnosed in the absence of itching. Conclusions The findings suggest that the baby's sex does not impact the occurrence, timing of diagnosis, peak bile acid levels, or itch severity in ICP. The findings that 5.6% of the ICP pregnancies in the present study were diagnosed in the first trimester and 1.8% were diagnosed without the presence of itching reinforce the need to investigate these less common presentations. More studies are needed to determine if these findings are consistent across other populations.

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Section: Introductionmentioning

confidence: 99%

Intrahepatic Cholestasis of Pregnancy: Role of Baby’s Sex on Itch Severity and Bile Acid Levels

Bartolone¹,

Mayrovitz²

2021

Cureus

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“…Epidemiology ICP is the most common pregnancy-related disease of the liver [1]. Due to ethnicity, its prevalence varies greatly between geographical regions and is significantly higher in Latin American than Caucasian women [2].…”

Section: Statement By the Working Group On Obstetrics And Prenatal Medicinementioning

confidence: 99%

“…Die ICP ist die häufigste schwangerschaftsbedingte Lebererkrankung 1 . Die Prävalenz variiert stark zwischen geografischen Regionen bedingt durch Ethnizität und ist unter lateinamerikanischen Frauen deutlich höher als unter kaukasischen Frauen 2 .…”

Section: Epidemiologieunclassified

Management of Intrahepatic Cholestasis of Pregnancy: Recommendations of the Working Group on Obstetrics and Prenatal Medicine – Section on Maternal Disorders

Hagenbeck

Hamza

Kehl

et al. 2021

Geburtshilfe Frauenheilkd.

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Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disease specific to pregnancy. The cardinal symptom of pruritus and a concomitant elevated level of bile acids in the serum and/or alanine aminotransferase (ALT) are suggestive for the diagnosis. Overall, the maternal prognosis is good. The fetal outcome depends on the bile acid level. ICP is associated with increased risks for adverse perinatal outcomes, including preterm delivery, meconium-stained amniotic fluid, and stillbirth. Acute fetal asphyxia and not chronic uteroplacental dysfunction leads to stillbirth. Therefore, predictive fetal monitoring is not possible. While medication with ursodeoxycholic acid (UDCA) improves pruritus, it has not been shown to affect fetal outcome. The indication for induction of labour depends on bile acid levels and gestational age. There is a high risk of recurrence in subsequent pregnancies.

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“…Additional symptoms of severe preeclampsia are liver dysfunction together with abdominal pain, nausea and vomiting [34]. Another frequent symptom of preeclampsia relates to dysfunctional coagulation, which can be a consequence of thrombotic microangiopathy [35,36], Ensuing thrombocytopenia and hemolysis are characteristic features, which are frequently associated with severe preeclampsia [35,36].…”

Section: Major Symptoms Of Preeclampsiamentioning

confidence: 99%

Pathological AT1R-B2R Protein Aggregation and Preeclampsia

Quitterer

AbdAlla

2021

Cells

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Preeclampsia is one of the most frequent and severe complications of pregnancy. Symptoms of preeclampsia usually occur after 20 weeks of pregnancy and include hypertension and kidney dysfunction with proteinuria. Up to now, delivery of the infant has been the most effective and life-saving treatment to alleviate symptoms of preeclampsia because a causative treatment does not exist, which could prolong a pregnancy complicated with preeclampsia. Preeclampsia is a complex medical condition, which is attributed to a variety of different risk factors and causes. Risk factors account for insufficient placentation and impaired vasculogenesis and finally culminate in this life-threatening condition of pregnancy. Despite progress, many pathomechanisms and causes of preeclampsia are still incompletely understood. In recent years, it was found that excessive protein complex formation between G-protein-coupled receptors is a common sign of preeclampsia. Specifically, the aberrant heteromerization of two vasoactive G-protein-coupled receptors (GPCRs), the angiotensin II AT1 receptor and the bradykinin B2 receptor, is a causative factor of preeclampsia symptoms. Based on this knowledge, inhibition of abnormal GPCR protein complex formation is an experimental treatment approach of preeclampsia. This review summarizes the impact of pathological GPCR protein aggregation on symptoms of preeclampsia and delineates potential new therapeutic targets.

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Liver disease in pregnancy

Cited by 20 publications

References 61 publications

Intrahepatic Cholestasis of Pregnancy: Role of Baby’s Sex on Itch Severity and Bile Acid Levels

Intrahepatic Cholestasis of Pregnancy: Role of Baby’s Sex on Itch Severity and Bile Acid Levels

Management of Intrahepatic Cholestasis of Pregnancy: Recommendations of the Working Group on Obstetrics and Prenatal Medicine – Section on Maternal Disorders

Pathological AT1R-B2R Protein Aggregation and Preeclampsia

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