Indian National Association for the Study of the Liver—Federation of Obstetric and Gynaecological Societies of India Position Statement on Management of Liver Diseases in Pregnancy

Abstract

Liver diseases occurring during pregnancy can be serious and can progress rapidly, affecting outcomes for both the mother and fetus. They are a common cause of concern to an obstetrician and an important reason for referral to a hepatologist, gastroenterologist, or physician. Liver diseases during pregnancy can be divided into disorders unique to pregnancy, those coincidental with pregnancy, and preexisting liver diseases exacerbated by pregnancy. A rapid differential diagnosis between liver diseases related or unrelated to pregnancy is required so that specialist and urgent management of these conditions can be carried out. Specific Indian guidelines for

Hepatitis C Virus Infection in Pregnancy and Children: Its Implications and Treatment Considerations with Directly Acting Antivirals: A Review

“…Therefore, ribavirin is contraindicated for both HCVinfected childbearing women and HCV-infected male partners of any reproductive age group women, unless they take effective contraceptive measures. 12,24,32,44 Besides, ribavirin-induced spermatogenic abnormalities (cell toxicity, mutagenicity, and a decreased epididymal sperm count) reverted only 4-8 months after treatment withdrawal in all animal species studied. Therefore, women are advised to avoid pregnancy for at least 6 months after completion of ribavirin treatment for their male partners.…”

“…29 Therefore, periodic HCV RNA evaluation should be performed 9-12 months post-delivery to assess the spontaneous clearance before considering DAA treatment. 32 Meta-analysis results demonstrated HCV infected pregnant women have a higher incidence of intrahepatic cholestasis compared to non-infected pregnant women. Additionally, those HCV-infected pregnant women who have intrahepatic cholestasis of pregnancy and higher viral loads have a higher rate of maternal and fetal adverse outcomes.…”

“…An elective cesarean section could be recommended for HCV twin pregnancy to avoid premature rupture of the membrane and to lower risk to the second twin. 8,12,28,32,42 A few studies have revealed twofold higher perinatal transmission in females compared with males, indicating genetic or hormonal factors may affect the susceptibility to HCV infections. 39 Apart from HCV infection, the risk of MTCT for HIV without HAART is 17-25% and that for HBV without prophylaxis is 30-40%, which is significantly reduced to 1-2% with HAART in HIV and 3-4% with HBV prophylaxis.…”

“…Therefore, women are advised to avoid pregnancy for at least 6 months after completion of ribavirin treatment for their male partners. 24,32,57…”

Evaluation of HBsAg, Anti-HCV Seroprevalence and Hepatitis B Immunity in Pregnant Women: A Descriptive Study

“…Hepatit B virüs (HBV) enfeksiyonu ve hepatit C virüs (HCV) enfeksiyonu gebelikte görülen karaciğer hastalıkları etiyolojisinde yer almaktadır. HBV ve HCV enfeksiyonu intrauterin, intrapartum veya doğum sonrası yollarla enfekte anneden fetusa aktarılabilir (1).…”