Jaundice and Pregnancy: Why Going Viral Is Out of Style

Cohen, Erica; Tran, Tram T.

doi:10.1007/s10620-016-4372-2

Cited by 1 publication

(3 citation statements)

References 7 publications

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“…We were surprised to find no cases of viral hepatitis A through E in pregnancy during the 22 years of this study, given that earlier studies featured viral hepatitis (VH) as the most common cause of jaundice in pregnancy . The low incidence of VH in our cohort may be attributable to previous hepatitis A and B vaccinations among younger American patients . Hepatitis E, long recognized as particularly prevalent in the developing world, was also not noted in the present study, likely because of the different genotypes and disease patterns observed in North America that do not seem prone to severe liver injury .…”

Section: Discussioncontrasting

confidence: 74%

“…(29,30) The low incidence of VH in our cohort may be attributable to previous hepatitis A and B vaccinations among younger American patients. (31,32) Hepatitis E, long recognized as particularly prevalent in the developing world, was also not noted in the present study, likely because of the different genotypes and disease patterns observed in North America that do not seem prone to severe liver injury. (33,34) We also did not identify any patients with intrahepatic cholestasis of pregnancy leading to ALF or ALI, given that this group does not typically lead to severe liver cell injury, though it may occur in the third trimester.…”

Section: Discussioncontrasting

confidence: 58%

“…All PAALD patients were enrolled in the study postpartum, given that emergent delivery of the infant invariably had occurred once the obstetrical team became aware of a liver-related issue. Median gestational age of the PAALD group was 36 weeks (range, [28][29][30][31][32][33][34][35][36][37][38][39]. PAALD patients were further adjudicated as AFLP (n = 14), HELLP (n = 16), and those where delineation was uncertain (n = 5; Tables 3 and 4).…”

Section: Overall Groupmentioning

confidence: 99%

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Acute Liver Failure (ALF) in Pregnancy: How Much Is Pregnancy Related?

et al. 2020

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BaCKgRoUND aND aIMS: Acute liver failure (ALF), characterized by sudden onset of coagulopathy (international normalized ratio [INR] ≥ 1.5) and encephalopathy, may occur during pregnancy either as a pregnancy-associated etiology or an unrelated and coincidental liver injury. The U.S. Acute Liver Failure Study Group, comprised of 33 tertiary care liver centers, has enrolled consecutive patients with ALF or acute liver injury (ALI; INR ≥ 2.0 with no encephalopathy), over two decades. appRoaCH aND ReSUltS: Etiologies, clinical features, and outcomes of 70 of 3,155 patients (2.2%) who developed ALF or ALI during pregnancy were reviewed to determine how many were pregnancy associated (pregnancy-associated liver disease; PAALD) and how many were attributed to other etiologies. Thirty-five of the 70 were considered PAALD, of whom nearly half were attributed to hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome and half to acute fatty liver of pregnancy (AFLP), although, in some instances, the distinction was unclear. Virtually all with PAALD had been delivered before hepatology referral, mostly by cesarean section. Acetaminophen toxicity accounted for 21 (60% of the remaining cases), with the remainder resulting from a variety of other causes, but not including viral hepatitis A through E. Although recovery with delivery or supportive measures was possible in most cases, 11 of 70 (16%) required liver transplantation and 8 (11%) died. Swansea criteria to diagnose AFLP were met by all patients with PAALD and also by virtually all women with other forms of ALF. CoNClUSIoNS: Only half of those with ALF during pregnancy appeared to have HELLP or AFLP. Morbidity and mortality for mother and fetus are strongly associated with etiology of liver failure. (Hepatology 2020;72:1366-1377). A cute liver failure (ALF) is a rare condition, affecting approximately 2,000-3,000 patients annually in the United States. (1) ALF occurring in pregnancy is associated with significant maternal and fetal morbidity and mortality. (2,3) Certain liver conditions that lead to ALF, such as hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome and acute fatty liver of pregnancy (AFLP), are limited solely to pregnant women, occur during the third trimester, and can be classified as pregnancy-associated acute liver diseases (PAALDs). (4-6) In the obstetrical literature, diagnostic criteria for AFLP, known as the Swansea criteria, have been proposed as a means to distinguish AFLP from other causes of liver dysfunction, including HELLP, but these have not been extensively validated. (7,8) Not all ALF that occurs during pregnancy is directly related to the pregnancy itself. For example, certain viruses occur relatively frequently in the reproductive years; likewise, pregnant women may be more susceptible to

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Section: Discussioncontrasting

confidence: 74%