Pregnancy outcome in women undergoing liver biopsy during pregnancy: A nationwide population‐based cohort study

Ludvigsson, Jonas F.; Marschall, Hanns‐Ulrich; Hagström, Hannes; Höijer, Jonas; Stephansson, Olof

doi:10.1002/hep.29345

Cited by 21 publications

(16 citation statements)

References 26 publications

(37 reference statements)

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“…23 In one small study, there was a small increased risk of premature birth, but no stillbirth was reported. 24 In some non-life-threatening clinical conditions, it may be reasonable to wait until delivery of the baby. Thus, the benefits of biopsy need to be balanced against the risks to the mother and baby.…”

Section: Pregnancymentioning

confidence: 99%

Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology

Neuberger

Patel

Caldwell

et al. 2020

Gut

229

201

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Liver biopsy is required when clinically important information about the diagnosis, prognosis or management of a patient cannot be obtained by safer means, or for research purposes. There are several approaches to liver biopsy but predominantly percutaneous or transvenous approaches are used. A wide choice of needles is available and the approach and type of needle used will depend on the clinical state of the patient and local expertise but, for non-lesional biopsies, a 16-gauge needle is recommended. Many patients with liver disease will have abnormal laboratory coagulation tests or receive anticoagulation or antiplatelet medication. A greater understanding of the changes in haemostasis in liver disease allows for a more rational, evidence-based approach to peri-biopsy management. Overall, liver biopsy is safe but there is a small morbidity and a very small mortality so patients must be fully counselled. The specimen must be of sufficient size for histopathological interpretation. Communication with the histopathologist, with access to relevant clinical information and the results of other investigations, is essential for the generation of a clinically useful report.

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Section: Pregnancymentioning

confidence: 99%

Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology

Neuberger

Patel

Caldwell

et al. 2020

Gut

229

201

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“…Patient characteristics may differ from that of the general patient population, if histopathology report data are used to identify diseases that may otherwise not require biopsy, or where biopsy is typically carried out only for advanced disease. The ESPRESSO database is likely to have lower coverage for certain gastrointestinal diseases in patients where endoscopy102 and, eg, liver biopsy103 are sometimes avoided due to other concurrent conditions (eg, pregnancy). The new recommendations allowing for a non-biopsy celiac diagnosis in certain children,27 but not in adults,117 mean that not all children with incident celiac disease after 2012 may have been identified.…”

Section: Discussionmentioning

confidence: 99%

“…Of note, the ESPRESSO database includes information on procedures. Two recent papers failed to detect any substantial impact on pregnancy outcome from endoscopy or liver biopsy during pregnancy 102,103. Yet, pregnancy outcome may not only be seen as a consequence of parental gastrointestinal disease,101,104 ie, it could also be a risk factor for future gastrointestinal disease in the offspring 105–107.…”

Section: Potential Research Use Of the Espresso Databasementioning

confidence: 99%

Cohort profile: ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden)

Ludvigsson¹,

Lashkariani²

2019

CLEP

Self Cite

126

135

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The ESPRESSO study constitutes a novel approach to examine the etiology and prognosis of gastrointestinal disease in which histopathology plays a prominent role. Between 2015 and 2017, all pathology departments (n=28) in Sweden were contacted and asked to procure histopathology record data from the gastrointestinal tract (pharynx to anus), liver, gallbladder, and pancreas. For each individual, local histopathology IT personnel retrieved data on personal identity number, date of histopathology, topography (where the biopsy is taken), morphology (biopsy appearance), and where available free text. In total, between 1965 and 2017, histopathology record data were available in 2.1 million unique individuals, but the number of data entries was 6.1 million because more than one biopsy was performed in many of the study participants. Index individuals with histopathology data were matched with up to five controls from the general population. We also identified all first-degree relatives (parents, children, full siblings), and the index individual’s first spouse. The total study population consisted of 13.0 million individuals. Data from all the study participants have been linked to Swedish National Healthcare Registers allowing research not only on such aspects as fetal and perinatal conditions and the risk of future gastrointestinal disease but also on the risk of comorbidity and complications (including cancer and death). Furthermore, the ESPRESSO database allows researchers and practitioners to identify diagnoses and disease phenotypes not currently indexed in national registers (including disease precursors). The ESPRESSO database increases the sensitivity and specificity of already-recorded diseases in the national health registers. This paper is an overview of the ESPRESSO database.

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“…This study demonstrated no increased risk of bleeding or stillbirth. There was a moderate increased risk of preterm birth and small for gestational age [7].…”

Section: Introductionmentioning

confidence: 97%

Liver Disease in Pregnancy and Transplant

Alghamdi

Fleckenstein

2019

Curr Gastroenterol Rep

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Purpose of Review The purpose of this review is to discuss current and new knowledge regarding liver disease in pregnancy and pregnancy post-liver transplantation. Recent Findings Severe liver disease associated with pregnancy is rare. Liver biopsy is rarely needed for diagnosis but is safe in selected cases. Intrahepatic cholestasis of pregnancy (ICP) with serum bile acids level > 40 μmol/L is associated with adverse fetal outcomes. Ursodeoxycholic acid should be initiated at diagnosis. Portal hypertension can worsen during pregnancy and screening endoscopy should be performed in the 2nd trimester. Maternal hepatitis B antiviral therapy can be considered in the 3rd trimester if HVB DNA > 200,000 IU/ml. Tacrolimus is the optimal immunosuppressive therapy during pregnancy post-transplantation. Preconception renal function predicts pregnancy outcome. Overall, the outcome of pregnancy post-transplantation is good but there is an increased risk of preterm delivery, low birth weight, hypertension, and pre-eclampsia. Summary Liver disease of pregnancy can be divided into diseases unique to pregnancy, exacerbated by pregnancy or coexisting with pregnancy. Overall, the outcome of pregnancy post-liver transplantation is good.

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Pregnancy outcome in women undergoing liver biopsy during pregnancy: A nationwide population‐based cohort study

Cited by 21 publications

References 26 publications

Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology

Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology

Cohort profile: ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden)

Liver Disease in Pregnancy and Transplant

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