Successful pregnancies and abortions in symptomatic and asymptomatic Wilson's disease

Sinha, Sanjib; Taly, Arun B.; Prashanth, L.K.; Arunodaya, G. R.; Swamy, H. S.

doi:10.1016/j.jns.2003.08.007

Cited by 90 publications

(48 citation statements)

References 14 publications

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“…WD is postulated to lead to reduced fertility as copper deposition in the uterus may interfere with embryo implantation leading to an increase in miscarriages and spontaneous abortions ( 151 ). 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.…”

Section: Primary Biliary Cirrhosismentioning

confidence: 99%

ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

242

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

242

257

View full text Add to dashboard Cite

show abstract

“…Another possible explanation of this quiescence may be sharing of the maternal copper burden by growing foetus. Whereas, the fate of pregnancy in untreated woman is usually fatal due to placental transfer of high copper load [2,3]. This woman had poor obstetric carrier as she was previously remained undiagnosed.…”

Section: Discussionmentioning

confidence: 96%

“…Treatment with zinc salt during this pregnancy resulted in successful pregnancy outcome. Different studies in this context concluded, treatment with copper chelating agents in women with WD improved their pregnancy outcome [1][2][3]. Penicillamine, zinc salts or trientine, all had equal effi cacy and safety pattern in respect to this [1].…”

Section: Discussionmentioning

confidence: 99%

“…Untreated Wilson's disease (WD) is associated with poor pregnancy outcome [1,2]. Excess copper from maternal circulation transported through placenta either led to spontaneous abortion or intrauterine fetal death (IUFD) [2,3].…”

mentioning

confidence: 99%

“…Excess copper from maternal circulation transported through placenta either led to spontaneous abortion or intrauterine fetal death (IUFD) [2,3]. Treatment with copper chelating agents started prenatally may improve the scenario [1][2][3].…”

mentioning

confidence: 99%

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