Pregnancy in Wilson's disease

Pfeiffenberger, Jan; Beinhardt, Sandra; Gotthardt, Daniel; Haag, Nicola; Freissmuth, C; Reuner, Ulrike; Gauss, Annika; Stremmel, Wolfgang; Schilsky, Michael L.; Ferenci, Péter; Weiss, Karl Heinz

doi:10.1002/hep.29490

Cited by 84 publications

(83 citation statements)

References 43 publications

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“…The vast majority of the patients included in this study had a history of pre-pregnancy hospitalization in which they received treatment with copper chelation therapy and disease evaluation during the first half of their pregnancy. These results are not completely consistent with the literature (15,19). Therefore, it is strongly recommended that women with WD need systematic evaluation and treatment during pre-pregnancy.Studies have found that the clinical effects of WD on pregnancy outcomes mainly include neurological symptoms in pregnant women, as well as spontaneous abortion (7)(8)19).…”

contrasting

confidence: 76%

“…These results are not completely consistent with the literature (15,19). Therefore, it is strongly recommended that women with WD need systematic evaluation and treatment during pre-pregnancy.Studies have found that the clinical effects of WD on pregnancy outcomes mainly include neurological symptoms in pregnant women, as well as spontaneous abortion (7)(8)19). The data analyzed in the present study showed that neurological symptoms were more frequent among women with WD than spontaneous abortions or liver and bone damage.…”

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confidence: 76%

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The study of Wilson Disease in pregnancy management

Pan

Han

et al. 2019

Preprint

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Background: Pregnancy management in women with Wilson disease (WD) remains an important clinical problem. This research was conducted to investigate how to avoid worsening of WD symptoms during pregnancy and increase pregnancy success in women with WD by identifying the best pregnancy management approaches in these patients. Methods: The clinical data of 117 pregnancies among 75 women with WD were retrospectively analyzed. Related information of the fetus was also recorded and analyzed. At the same time, regression analysis was performed for data of 22 pregnant women without WD, as normal controls. Results: Of a total of 117 pregnancies among the 75 women with WD and 31 pregnancies among the 22control womenincluded in this study, there were 108 successful pregnancies and 9 spontaneous abortions. Among the 108 successful pregnancies, 97 women a history of copper chelation therapy before pregnancy; all 97 women stopped anti-copper therapy during pregnancy. The nine women with spontaneous abortion had no pre-pregnancy history of copper displacement therapy. The incidence of lower limb edema was higher in the WD group than in normal controls (P=0.036). Compared with the control group, there was a higher proportion in the WD group of male infants (P=0.022) and lower average infant birth weight (t=3.514, P=0.001). Conclusion: It is relatively safe for women with WD patients to become pregnant. The best management method for pregnancy in women with WD may be intensive pre-pregnancy copper chelation therapy and no anti-copper treatment during pregnancy.

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confidence: 76%

contrasting

confidence: 76%

The study of Wilson Disease in pregnancy management

Pan

Han

et al. 2019

Preprint

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“…The current study was designed to analyze fetal and maternal outcomes and therapeutic effects in WD. Specifically, the study addresses three major concerns: (1) what is the risk of miscarriage in treated and untreated WD patients, (2) can WD worsen during pregnancy, and (3) are chelating agents during pregnancy safe?…”

Section: See Article On Page 1261mentioning

confidence: 99%

Pregnancy in Wilson disease

Rabiee

Hamilton

2018

Hepatology

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“…This differs from previous studies in which alcoholic liver disease was the main underlying cause of liver disease. This likely re ects a difference in the prevalence of liver disease in these populations [14][15][16] . In our study, patients with liver cirrhosis caused by Wilson's disease had a better prognosis than by HBV infection.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Maternal and Fetal Outcomes of Patients with Liver Cirrhosis:A Case-Control Study

Gao

Zhu

Liu

et al. 2020

Preprint

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Objective:We aimed to describe the characteristics and outcomes in pregnant women with liver cirrhosis, and identify the predictors of negative outcome of the mother and fetus.Methods: Retrospectively collect the mothers with liver cirrhosis in our center from 6/2010 to 6/2019. Women without liver cirrhosis were selected as a control in a 1:2 ratio. The primary assessment was the frequency of negative maternal and fetal outcomes. The secondary assessment was the negative outcomes between patients continuing the pregnancy or not and the factors to predict the severe negative outcomes.Results:Of 126 pregnancies enrolled, 29 pregnancies were discontinued for worrying the disease progression and 97 pregnancies were continued. 194 pregnancies without liver cirrhosis were selected as control. At baseline, patients with liver cirrhosis have a lower level of platelet, hemoglobin, Prothrombin activity, and a higher level of ALT, Total Bilirubin, Creatinine. Compared to control, patients with liver cirrhosis have a higher frequency of negative outcomes, including bleeding gums(7.2 %vs. 1.0%), TBA elevation (18.6 %vs.3.1%), infection (10.3 %vs.0.5%), cesarean section (73.6 %vs.49.5%), postpartum hemorrhage(13.8% vs 2.1%), blood transfusion (28.9% vs 2.1%), new ascites or aggravating ascites(6.2% vs.0%), MODS(7.2% vs.0.5%) and intensive care unit admissions(24.1% vs 1.1%). The incidence of severe maternal negative outcomes was also higher (32.0% vs 1.5%). Women who chose to discontinue the pregnancy had less severe negative outcomes (3.4% vs.32.0%).A higher frequency of fetal/infants complication were observed in liver cirrhosis population than control, including newborn asphyxia(10.2% vs1.1%), Low birth weight infant(13.6% vs. 2.6%) .In those patients who progressed into the third trimester, multivariable regression demonstrated that severe negative outcomes were associated with a higher CTP scores (OR 2.128, 95% CI[ 1.002, 4.521] ,p=0.049). Wilson’s disease related liver cirrhosis has a better prognosis (OR= 0.009, 95% CI[0, 0.763], p=0.038).Conclusions:The incidence of the negative outcomes was significantly increased in pregnancies complicated by cirrhosis. The predictor of severe negative outcomes is higher CTP score and Wilson’s disease induced liver cirrhosis have a better prognosis. Timely terminate the pregnancy during the first trimester may avoid the incidence of severe negative outcomes.

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Pregnancy in Wilson's disease

Cited by 84 publications

References 43 publications

The study of Wilson Disease in pregnancy management

The study of Wilson Disease in pregnancy management

Pregnancy in Wilson disease

Maternal and Fetal Outcomes of Patients with Liver Cirrhosis:A Case-Control Study

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