Pregnancy in women with primary biliary cirrhosis

Efe, Cumali; Kahramanoğlu-Aksoy, Evrim; Yılmaz, Bülent; Ozseker, Burak; Takçı, Şahin; Roach, Emir Charles; Pürnak, Tuğrul; Kav, Taylan; Özaslan, Ersan; Wåhlin, Staffan

doi:10.1016/j.autrev.2014.05.008

Cited by 44 publications

(58 citation statements)

References 39 publications

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“…UDCA is a pregnancy category B drug that is generally recommended for PBC ( 146 ). Studies on the use of UDCA treatment for PBC during pregnancy have been limited, especially in the fi rst trimester ( 147,148 ). Similar to the situation with AIH, the potential risks of UDCA during pregnancy appear small compared with the potential positive eff ect of treatment on maternal and fetal outcomes.…”

Section: Primary Biliary Cirrhosismentioning

confidence: 99%

ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

223

249

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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%

ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

223

249

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“…Nevertheless, in the largest population‐based study of PBC to date, the disease was not associated with decreased fertility, a finding which was replicated in a subsequent study . Though the literature on this topic is limited to small cohort studies and case–control studies, no significant or serious risk in fertility has been found thus far in women diagnosed with PBC …”

Section: Primary Biliary Cholangitismentioning

confidence: 80%

“…With respect to the impact of pregnancy on PBC, some studies have reported an improvement in the clinical course of PBC during pregnancy, which may be related to the increase in estrogen during pregnancy leading to a shift from a type 1 to a (anti‐inflammatory) type 2 cytokine profile . Some studies have reported de novo or significant exacerbations in pruritus during pregnancy, though other studies have reported improvement . Although not FDA‐approved for use during pregnancy, administration of UDCA can be effective in treating pruritus in some women and does not appear to pose significant fetal or maternal risk (throughout all gestational periods and during breastfeeding) .…”

Section: Primary Biliary Cholangitismentioning

confidence: 99%

“…Variceal bleeding is the most catastrophic complication of portal hypertension in pregnancy, and 75% of patients with esophageal varices experience bleeding during pregnancy due to hyperdynamic circulation and resultant increased flow in venous collaterals . Extensive pre‐conception counseling, staging the disease/determining the presence or absence of cirrhosis (with variceal ligation if needed), and antenatal monitoring by a multi‐disciplinary team are all essential measures to minimize complications …”

Section: Primary Biliary Cholangitismentioning

confidence: 99%

“…The majority of women with PBC are diagnosed during postmenopausal years. 134,135 However, histological findings of PBC can appear much earlier, and recent literature has reported that in up to 25% of female patients, PBC is diagnosed during reproductive years. 48,135,136 As mentioned above, younger women in child bearing age tend to be more symptomatic than older women with PBC.…”

Section: Fertility and Pregnancymentioning

confidence: 99%

See 2 more Smart Citations

Complications, symptoms, quality of life and pregnancy in cholestatic liver disease

Zakharia

Tabibian

Lindor

et al. 2017

Liver International

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Cholestatic liver diseases (CLDs) encompass a variety of disorders of bile formation and/or flow which generally result in progressive hepatobiliary injury and ultimately end-stage liver disease. Many patients with CLD are diagnosed between the ages of 20-50 years, a particularly productive period of life professionally, biologically and in other respects; it is not surprising, thus, that CLD is often associated with impaired health-related quality of life (HRQOL) and uncertainty regarding implications for and outcomes of pregnancy. Primary sclerosing cholangitis (PSC) and primary biliary cholangitis (PBC) are the most prominent CLDs, both having considerable morbidity and mortality and representing major indications for liver transplantation. These disorders, as a consequence of their complications (eg ascites, hepatic osteodystrophy), associated conditions (eg inflammatory bowel disease) and symptoms (eg pruritus and fatigue), can significantly impair an array of domains of HRQOL. Here we review these impactful clinical aspects of PSC and PBC as well as the topics of fertility and pregnancy.

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The Liver in Pregnancy

Reau

Bacq

2017

Schiff's Diseases of the Liver

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Pregnancy in women with primary biliary cirrhosis

Cited by 44 publications

References 39 publications

ACG Clinical Guideline: Liver Disease and Pregnancy

ACG Clinical Guideline: Liver Disease and Pregnancy

Complications, symptoms, quality of life and pregnancy in cholestatic liver disease

The Liver in Pregnancy

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