EASL Clinical Practice Guidelines on the management of liver diseases in pregnancy

Williamson, Catherine; Nana, Melanie; Poon, Liona C.; Kupčinskas, L.; Painter, Rebecca C.; Taliani, Gloria; Heneghan, Michael A.; Marschall, Hanns‐Ulrich; Beuers, Ulrich

doi:10.1016/j.jhep.2023.03.006

Cited by 27 publications

(8 citation statements)

References 462 publications

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“…Unfortunately, methyldopa is still recommended as a first-line antihypertensive agent in some practices, but, from our findings, we would recommend avoiding methyldopa use in pregnancy if alternative agents are available. [9][10][11] Clinicians should be aware that pregnancy-related abnormal liver tests may be attributable to medications started within the prior 3 months and can initially occur postpartum such as seen in autoimmune hepatitis. Clinicians should consult a liver specialist, exclude other common causes of pregnancy-related abnormal liver tests, use the National Institutes of Health's LiverTox website (https://ncbi.nlm.nih.gov/books/ NBK547852/) to identify the most likely causative medications, and discontinue likely causative medications promptly.…”

Section: Discussionmentioning

confidence: 99%

Drug-Induced Liver Injury in Pregnancy

Masood,

Venturini,

Nicoletti

et al. 2024

Obstetrics &Amp; Gynecology

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There are limited data on the causative agents and characteristics of drug-induced liver injury in pregnant individuals. Data from patients with drug-induced liver injury enrolled in the ongoing multicenter Drug-Induced Liver Injury Network between 2004 and 2022 and occurring during pregnancy or 6 months postpartum were reviewed and compared with cases of drug-induced liver injury in nonpregnant women of childbearing age. Among 325 individuals of childbearing age in the Drug-Induced Liver Injury Network, 16 cases of drug-induced liver injury (5%) occurred during pregnancy or postpartum. Compared with drug-induced liver injury in nonpregnant women, pregnancy-related drug-induced liver injury was more severe (P<.05). One elective termination and three miscarriages were documented; there were no maternal deaths. We recommend that isoniazid for latent tuberculosis be deferred to the postpartum period whenever feasible and that β-blockers or calcium channel blockers rather than methyldopa be used for hypertension management during pregnancy.

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Section: Discussionmentioning

confidence: 99%

Drug-Induced Liver Injury in Pregnancy

Masood,

Venturini,

Nicoletti

et al. 2024

Obstetrics &Amp; Gynecology

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“…8 ) [ 62 ]. Monitoring is recommended with ultrasound examinations each trimester [ 63 ]. Teamwork is essential in the evidence of growth or bleeding, the latter requiring trans-arterial embolization or surgery in some patients.…”

Section: Liver Diseases Exacerbated By or More Frequent During Pregnancymentioning

confidence: 99%

“…AH should be considered in the presence of sudden jaundice and acute liver injury or failure in pregnancy [ 50 , 68 – 70 ]. Although viral hepatitis (virus A to E) is the most common cause of jaundice in pregnancy worldwide [ 50 ], hepatotoxicity due to drug reactions, herbal or dietary supplements should be ruled out [ 63 – 69 ]. In India, the hepatitis E virus is a common cause of AH in pregnancy with a 25% mortality rate [ 8 , 50 ], while acetaminophen overdose is responsible for 30% of the cases of ALF in pregnancy in the USA [ 68 ].…”

Section: Coincidental Liver Diseasesmentioning

confidence: 99%

“…Cystic components may suggest a mucinous gastrointestinal or ovarian primary, while hyperenhancing lesions suggest a metastatic choriocarcinoma [ 76 ], sarcoma, and renal or neuroendocrine tumor. US surveillance is recommended each trimester in pregnant patients with a history of extrahepatic cancers known to metastasize to the liver [ 63 ]. Biopsy may also be considered whenever needed in incidental focal lesions, severe liver dysfunction in transplanted patients, or in cases of severe liver disease.…”

Section: Coincidental Liver Diseasesmentioning

confidence: 99%

“…Rapid and aggressive tumor growth is described, with a higher chance of rupture, probably due to estrogens and neovascularization [ 92 – 94 ]. Surveillance with US or MRI is recommended during each trimester in women at risk of HCC, [ 63 ]. When HCC is suspected, characterization by either contrast-enhanced MRI or CT should not be delayed [ 92 ].…”

Section: Coincidental Liver Diseasesmentioning

confidence: 99%

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Liver imaging and pregnancy: what to expect when your patient is expecting

Porrello,

Cannella,

Bernuau

et al. 2024

Insights Imaging

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Liver diseases in pregnancy can be specific to gestation or only coincidental. In the latter case, the diagnosis can be difficult. Rapid diagnosis of maternal-fetal emergencies and situations requiring specialized interventions are crucial to preserve the maternal liver and guarantee materno-fetal survival. While detailed questioning of the patient and a clinical examination are highly important, imaging is often essential to reach a diagnosis of these liver diseases and lesions. Three groups of liver diseases may be observed during pregnancy: (1) diseases related to pregnancy: intrahepatic cholestasis of pregnancy, pre-eclampsia, eclampsia, hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, and acute fatty liver of pregnancy; (2) liver diseases that are more frequent during or exacerbated by pregnancy: acute herpes simplex hepatitis, Budd-Chiari syndrome, hemorrhagic hereditary telangiectasia, hepatocellular adenoma, portal vein thrombosis, and cholelithiasis; (3) coincidental conditions, including acute hepatitis, incidental focal liver lesions, metabolic dysfunction–associated steatotic liver disease, cirrhosis, hepatocellular carcinoma, liver abscesses and parasitosis, and liver transplantation. Specific knowledge of the main imaging findings is required to reach an early diagnosis, for adequate follow-up, and to avoid adverse consequences in both the mother and the fetus.Critical relevance statement Pregnancy-related liver diseases are the most important cause of liver dysfunction in pregnant patients and, in pregnancy, even common liver conditions can have an unexpected turn. Fear of radiations should never delay necessary imaging studies in pregnancy.Key points• Pregnancy-related liver diseases are the most frequent cause of liver dysfunction during gestation.• Fear of radiation should never delay necessary imaging studies.• Liver imaging is important to assess liver emergencies and for the diagnosis and follow-up of any other liver diseases.• Common liver conditions and lesions may take an unexpected turn during pregnancy.• Pregnancy-specific diseases such as pre-eclampsia and HELLP syndrome must be rapidly identified. However, imaging should never delay delivery when it is considered to be urgent for maternal-fetal survival. Graphical Abstract

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Leber und Schwangerschaft

De Gottardi,

Stanek

2024

Schweiz. Gastroenterol.

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EASL Clinical Practice Guidelines on the management of liver diseases in pregnancy

Cited by 27 publications

References 462 publications

Drug-Induced Liver Injury in Pregnancy

Drug-Induced Liver Injury in Pregnancy

Liver imaging and pregnancy: what to expect when your patient is expecting

Leber und Schwangerschaft

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