Wilson’s disease in pregnancy: case series and review of literature

Malik, Ayesha; Khawaja, Ali; Sheikh, Lumaan

doi:10.1186/1756-0500-6-421

Cited by 49 publications

(43 citation statements)

References 16 publications

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“…WD and the complex nature of its management would benefi t from referral to high-risk pregnancy multidisciplinary specialists in maternal-fetal medicine and liver disease. Pregnancy in general does not appear to change the course of WD progression ( 152 ). However, treatment discontinuation or a lack of treatment has been reported to lead to disease fl ares with attendant risk of hepatic decompensation or liver failure ( 153 ).…”

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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“…Another series of 29 WD patients treated with zinc reported even no noticeable spontaneous abortions . Case reports have also described other successful pregnancies with zinc therapy …”

Section: Discussionmentioning

confidence: 99%

Pregnancy in Wilson's disease: Management and outcome

Pfeiffenberger¹,

Beinhardt

Gotthardt³

et al. 2018

Hepatology

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Pregnancy in WD patients on anticopper therapy is safe. The spontaneous abortion rate in treated patients was lower than that in therapy-naïve patients. Although the teratogenic potential of copper chelators is a concern, the rate of birth defects in our cohort was low. Treatment for WD should be maintained during pregnancy, and patients should be monitored closely for hepatic and neurological symptoms. (Hepatology 2018;67:1261-1269).

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“…Wilson's disease (WD) is an autosomal recessive genetic disorder in which defective biliary excretion of copper leads to its accumulation, especially in liver, brain and cornea [1]). It is found world-wide, with a prevelance of 1:30.000-1:100.000 live births [2].…”

Section: Introductionmentioning

confidence: 99%

“…Clinical manifestations can vary widely, but the key features of the disease are hepatic, neurophychiatric disturbances and Kayser-Fleischer rings in Descement membrane of the cornea. Hemolysis associated with acute liver failure is also a common finding [1][2][3]. Untreated Wilson's disease may lead to subfertility and pregnancy complications such as; recurrent miscarriages, induced hypertension, preeclampsia, placental abruption and intrauterine growth restriction [4].…”

Section: Introductionmentioning

confidence: 99%