Treatment of Wilson's disease with zinc. XVII: Treatment during pregnancy

Brewer, George J.; Johnson, Victoria; Dick, Robert; Hedera, Peter; Fink, John K.; Kluin, Karen J.

doi:10.1002/hep.510310216

Cited by 187 publications

(92 citation statements)

References 36 publications

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“…Th ere is inadequate data to make recommendations on a preferred treatment for WD during pregnancy, between penicillamine, trientine, or zinc. Some data on conversion to zinc therapy during pregnancy has also been reported (156)(157)(158). Th ere are also multiple case reports of fetal myelosuppression or embryopathy associated with penicillamine treatment during pregnancy for WD (159)(160)(161)(162).…”

Section: Primary Biliary Cirrhosismentioning

confidence: 99%

ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

235

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%

ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

235

257

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“…Zinc acetate was approved by the FDA in 1997 as a drug for Wilson's disease. 25) These facts suggest the safety of zinc supplementation in therapy.…”

Section: Discussionmentioning

confidence: 99%

Enhancing Effect of Zinc on Hepatoprotectivity of Epigallocatechin Gallate in Isolated Rat Hepatocytes.

Kagaya

Kawase

Maeda

et al. 2002

Biological & Pharmaceutical Bulletin

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“…Another possible explanation of this quiescence may be sharing of the maternal copper burden by growing foetus. Whereas, the fate of pregnancy in untreated woman is usually fatal due to placental transfer of high copper load [2,3]. This woman had poor obstetric carrier as she was previously remained undiagnosed.…”

Section: Discussionmentioning

confidence: 98%

“…Excess copper from maternal circulation transported through placenta either led to spontaneous abortion or intrauterine fetal death (IUFD) [2,3]. Treatment with copper chelating agents started prenatally may improve the scenario [1][2][3].…”

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confidence: 99%