-
Categories
-
Pharmaceutical Intermediates
-
Active Pharmaceutical Ingredients
-
Food Additives
- Industrial Coatings
- Agrochemicals
- Dyes and Pigments
- Surfactant
- Flavors and Fragrances
- Chemical Reagents
- Catalyst and Auxiliary
- Natural Products
- Inorganic Chemistry
-
Organic Chemistry
-
Biochemical Engineering
- Analytical Chemistry
- Cosmetic Ingredient
-
Pharmaceutical Intermediates
Promotion
ECHEMI Mall
Wholesale
Weekly Price
Exhibition
News
-
Trade Service
It is not uncommon for liver diseases to occur during pregnancy
.
Liver disease during pregnancy can be caused by pregnancy-specific diseases, as well as by acute or chronic conditions that have existed or occurred during pregnancy
.
Pregnancy-specific diseases include hyperemesis gravidarum (HG), hypertension of pregnancy, intrahepatic cholestasis of pregnancy (ICP) and acute fatty liver of pregnancy (AFLP)
.
Hypertension in pregnancy includes preeclampsia/eclampsia, hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome
.
Chronic liver diseases that may be affected by pregnancy or exacerbated by pregnancy include autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and non-alcoholic fatty liver disease ( NAFLD)
.
Timely diagnosis and treatment of liver disease during pregnancy is very important, otherwise it may lead to adverse maternal and fetal outcomes
.
This review discusses and summarizes the research progress of liver disease in pregnancy in recent years to help doctors understand the disease more deeply and improve patient outcomes
.
Liver disease caused by pregnancy-specific diseases It is very important to understand the liver disease caused by pregnancy-specific diseases to determine the patient's pregnancy stage (Table 1)
.
HG usually occurs in the first trimester
.
HELLP syndrome and ICP should be considered in the second trimester
.
Except for HG, all diseases may be the cause of liver damage in the third trimester of pregnancy
.
Table 1 Liver disease caused by pregnancy-specific diseases Note: AST, aspartate aminotransferase; ALT, alanine aminotransferase; LDH, lactate dehydrogenase; US, the incidence of hyperemesis gravidarum HG in 0.
3% Between ~2%, 50%~60% of patients can see liver involvement, and the clinical manifestations are excessive nausea, vomiting, weight loss, and dehydration
.
Treatment depends on the severity of symptoms, including intravenous fluids, antiemetics, and vitamin and mineral supplements
.
Encourage mothers to eat fewer meals and focus on high-carbohydrate and low-fat diets
.
Since elevated liver enzymes subside on their own within about 20 weeks of pregnancy, maternal and fetal outcomes are excellent
.
Pre-eclampsia/pre-eclampsia/eclampsia is a part of pregnancy-induced hypertension.
Pre-eclampsia is relatively common, with an incidence of 2% to 8%
.
The most common symptoms of preeclampsia/eclampsia are persistent and severe headaches, visual disturbances, epigastric pain, vomiting, and peripheral edema
.
In 20% to 30% of cases, liver involvement occurs, usually with mild to moderate elevation of AST/ALT
.
It is recommended that high-risk patients use low-dose aspirin to prevent pre-eclampsia/eclampsia
.
Antihypertensive drugs and magnesium are used to control hypertensive crisis and seizures, respectively
.
Liver damage associated with preeclampsia/eclampsia is not progressive and does not require specific treatment
.
Hemolysis, elevated liver enzymes and low platelet count syndrome HELLP syndrome is a part of pregnancy-induced hypertension, with an incidence of 0.
2% to 0.
6%, and an incidence of 10% to 20% in patients with preeclampsia/eclampsia
.
Pain in the upper abdomen/right upper abdomen is the most characteristic symptom of HELLP syndrome, usually related to nausea and vomiting.
Any pregnant woman who has such pain suddenly in the second half of pregnancy, especially when accompanied by nausea and vomiting, should consider HELLP syndrome Existence
.
Other symptoms include malaise, headache, severe systolic/diastolic hypertension and proteinuria
.
The diagnosis and severity grading system of HELLP syndrome are shown in Table 2
.
Table 2 Grading system of HELLP syndrome Note: ELLP, no hemolysis (increased liver enzymes and decreased platelet count); EL, increased liver enzymes; LP, decreased platelet count; N/A, not applicable to mother and fetus with HELLP syndrome Both are a life-threatening disease
.
Although emergency delivery is the only treatment, elevated transaminase may last up to 48 hours postpartum
.
For liver rupture, hematoma, and decompensation, emergency treatment including radiological or surgical intervention and liver transplantation is required, especially when liver, kidney, and blood system complications still exist 72 hours after delivery
.
If the patient is less than a month old, medications include low-dose aspirin, intravenous magnesium, and antihypertensive drugs
.
The Mississippi Protocol strongly recommends intravenous corticosteroids, especially high-dose dexamethasone, combined with magnesium sulfate and systolic blood pressure control
.
Intrahepatic cholestasis of pregnancy ICP refers to the obstruction of intrahepatic bile flow, which leads to retention in the liver and spilling into the blood.
It is the most common liver disease unique to pregnancy
.
Some adverse outcomes (including premature birth, meconium contamination of amniotic fluid, and fetal death) are related to ICP
.
The most common symptoms of ICP are moderate to severe itching without a rash, starting from the palms and soles and extending to the whole body
.
It often worsens at night, disturbs sleep and induces irritability
.
Other symptoms include jaundice, epigastric pain, fatigue, and anorexia
.
A significant increase in serum total bile acid levels was observed, reflecting bile retention
.
The focus of treatment is to reduce maternal symptoms and prevent fetal distress
.
The European Society for Liver Research recommends ursodeoxycholic acid (UDCA) 10-15 mg/kg/day as first-line treatment
.
In severe ICP with refractory symptoms, early delivery is the only way to benefit the outcome
.
Acute fatty liver of pregnancy AFLP is rare, but it is a potentially fatal emergency, which can lead to serious maternal and fetal complications
.
The stillbirth rate is high, and the maternal mortality rate is about 12%
.
The early manifestations of AFLP are non-specific, similar to preeclampsia and HELLP syndrome
.
The most common symptoms include anorexia, nausea and vomiting, and epigastric pain, followed by signs of acute liver failure, such as encephalopathy and jaundice
.
Transaminase can rise up to 20 times
.
Coagulopathy can also be observed in AFLP and HELLP syndromes, caused by decreased AFLP synthesis and increased HELLP consumption
.
AFLP usually requires intensive care treatment
.
In most cases, immediate delivery is the first-line treatment, but laboratory and clinical abnormalities may last up to a week after delivery
.
Fetuses born to AFLP patients are at higher risk of liver failure, cardiomyopathy, nonketotic hypoglycemia, myopathy, and neuropathy
.
In addition, AFLP may recur in subsequent pregnancies
.
Liver diseases that may develop into pregnancy complications Chronic liver diseases that may be affected by pregnancy or exacerbated by pregnancy include AIH, PBC, PSC, and NAFLD
.
Autoimmune hepatitis AIH is a chronic inflammatory liver disease.
Histological examination shows that it is characterized by elevated transaminases, appearance of anti-nuclear or anti-smooth muscle antibodies, elevated IgG, and interface hepatitis/plasma-lymphocyte inflammation
.
Controlled AIH is not a contraindication to pregnancy, but women with liver cirrhosis are at the highest risk of adverse outcomes and require close monitoring
.
Regarding drug treatment, no significant relationship has been found between the use of immunosuppressants (corticosteroids and azathioprine) during pregnancy and adverse outcomes
.
In order to prevent possible adverse outcomes due to poor disease control, it is recommended to maintain immunosuppressive therapy, but mycophenolate mofetil is forbidden
.
Hepatitis may occur after delivery, so the mother should be closely monitored for at least six months after delivery
.
Primary biliary cholangitis and primary sclerosing cholangitis PBC and PSC are chronic cholestatic liver diseases
.
PBC may progress to liver cirrhosis and liver failure
.
Like AIH, PBC mainly occurs in middle-aged women, but it can also occur in young women
.
Pregnancy in patients with non-cirrhotic PBC is not associated with an increased risk of adverse maternal or fetal outcomes
.
However, due to the high risk of potential childbirth complications, pregnancy and childbirth must be closely monitored
.
About half of pregnant women with PBC may experience new itching or worsening of itching, and occasionally need anti-itch treatment
.
UDCA is safe and well tolerated by pregnant women and should not be discontinued
.
Bezafibrate is often used as a second-line treatment of PBC in Japan and is contraindicated during pregnancy
.
PSC mainly involves daring ducts inside and outside the liver
.
Unlike PBC, PSC is more common in men, with adolescents and young adults at the highest risk
.
Although 20% and 32% of patients have elevated liver enzymes during pregnancy and postpartum, respectively, the clinical course of PSC is not affected by pregnancy
.
Patients with PSC may experience new itching or worsening of itching
.
Although the available data are limited, the maternal and fetal prognosis of pregnant women with PBC and PSC is good, and it is recommended to closely monitor and treat possible pruritus
.
Non-alcoholic fatty liver disease NAFLD is the most common liver disease in women of childbearing age
.
Although data on the effects of NAFLD on the mother and fetus are scarce, several studies have shown that it has a negative impact on pregnancy outcomes
.
Gestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy, and its correlation with NAFLD is likely to be bidirectional
.
NAFLD in the first trimester is significantly associated with an increased risk of GDM, and previous GDM is also a predictor of postpartum NAFLD
.
In order to reduce the burden of NAFLD on the mother and fetus, it is extremely important to control prenatal hyperglycemia, prevent GDM, and avoid excessive weight gain during pregnancy
.
Literature index: Sasamori Y, Tanaka A, Ayabe T.
Liver disease in pregnancy.
Hepatol Res.
2020 Jun 24.
doi: 10.
1111/hepr.
13540.
.
Liver disease during pregnancy can be caused by pregnancy-specific diseases, as well as by acute or chronic conditions that have existed or occurred during pregnancy
.
Pregnancy-specific diseases include hyperemesis gravidarum (HG), hypertension of pregnancy, intrahepatic cholestasis of pregnancy (ICP) and acute fatty liver of pregnancy (AFLP)
.
Hypertension in pregnancy includes preeclampsia/eclampsia, hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome
.
Chronic liver diseases that may be affected by pregnancy or exacerbated by pregnancy include autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and non-alcoholic fatty liver disease ( NAFLD)
.
Timely diagnosis and treatment of liver disease during pregnancy is very important, otherwise it may lead to adverse maternal and fetal outcomes
.
This review discusses and summarizes the research progress of liver disease in pregnancy in recent years to help doctors understand the disease more deeply and improve patient outcomes
.
Liver disease caused by pregnancy-specific diseases It is very important to understand the liver disease caused by pregnancy-specific diseases to determine the patient's pregnancy stage (Table 1)
.
HG usually occurs in the first trimester
.
HELLP syndrome and ICP should be considered in the second trimester
.
Except for HG, all diseases may be the cause of liver damage in the third trimester of pregnancy
.
Table 1 Liver disease caused by pregnancy-specific diseases Note: AST, aspartate aminotransferase; ALT, alanine aminotransferase; LDH, lactate dehydrogenase; US, the incidence of hyperemesis gravidarum HG in 0.
3% Between ~2%, 50%~60% of patients can see liver involvement, and the clinical manifestations are excessive nausea, vomiting, weight loss, and dehydration
.
Treatment depends on the severity of symptoms, including intravenous fluids, antiemetics, and vitamin and mineral supplements
.
Encourage mothers to eat fewer meals and focus on high-carbohydrate and low-fat diets
.
Since elevated liver enzymes subside on their own within about 20 weeks of pregnancy, maternal and fetal outcomes are excellent
.
Pre-eclampsia/pre-eclampsia/eclampsia is a part of pregnancy-induced hypertension.
Pre-eclampsia is relatively common, with an incidence of 2% to 8%
.
The most common symptoms of preeclampsia/eclampsia are persistent and severe headaches, visual disturbances, epigastric pain, vomiting, and peripheral edema
.
In 20% to 30% of cases, liver involvement occurs, usually with mild to moderate elevation of AST/ALT
.
It is recommended that high-risk patients use low-dose aspirin to prevent pre-eclampsia/eclampsia
.
Antihypertensive drugs and magnesium are used to control hypertensive crisis and seizures, respectively
.
Liver damage associated with preeclampsia/eclampsia is not progressive and does not require specific treatment
.
Hemolysis, elevated liver enzymes and low platelet count syndrome HELLP syndrome is a part of pregnancy-induced hypertension, with an incidence of 0.
2% to 0.
6%, and an incidence of 10% to 20% in patients with preeclampsia/eclampsia
.
Pain in the upper abdomen/right upper abdomen is the most characteristic symptom of HELLP syndrome, usually related to nausea and vomiting.
Any pregnant woman who has such pain suddenly in the second half of pregnancy, especially when accompanied by nausea and vomiting, should consider HELLP syndrome Existence
.
Other symptoms include malaise, headache, severe systolic/diastolic hypertension and proteinuria
.
The diagnosis and severity grading system of HELLP syndrome are shown in Table 2
.
Table 2 Grading system of HELLP syndrome Note: ELLP, no hemolysis (increased liver enzymes and decreased platelet count); EL, increased liver enzymes; LP, decreased platelet count; N/A, not applicable to mother and fetus with HELLP syndrome Both are a life-threatening disease
.
Although emergency delivery is the only treatment, elevated transaminase may last up to 48 hours postpartum
.
For liver rupture, hematoma, and decompensation, emergency treatment including radiological or surgical intervention and liver transplantation is required, especially when liver, kidney, and blood system complications still exist 72 hours after delivery
.
If the patient is less than a month old, medications include low-dose aspirin, intravenous magnesium, and antihypertensive drugs
.
The Mississippi Protocol strongly recommends intravenous corticosteroids, especially high-dose dexamethasone, combined with magnesium sulfate and systolic blood pressure control
.
Intrahepatic cholestasis of pregnancy ICP refers to the obstruction of intrahepatic bile flow, which leads to retention in the liver and spilling into the blood.
It is the most common liver disease unique to pregnancy
.
Some adverse outcomes (including premature birth, meconium contamination of amniotic fluid, and fetal death) are related to ICP
.
The most common symptoms of ICP are moderate to severe itching without a rash, starting from the palms and soles and extending to the whole body
.
It often worsens at night, disturbs sleep and induces irritability
.
Other symptoms include jaundice, epigastric pain, fatigue, and anorexia
.
A significant increase in serum total bile acid levels was observed, reflecting bile retention
.
The focus of treatment is to reduce maternal symptoms and prevent fetal distress
.
The European Society for Liver Research recommends ursodeoxycholic acid (UDCA) 10-15 mg/kg/day as first-line treatment
.
In severe ICP with refractory symptoms, early delivery is the only way to benefit the outcome
.
Acute fatty liver of pregnancy AFLP is rare, but it is a potentially fatal emergency, which can lead to serious maternal and fetal complications
.
The stillbirth rate is high, and the maternal mortality rate is about 12%
.
The early manifestations of AFLP are non-specific, similar to preeclampsia and HELLP syndrome
.
The most common symptoms include anorexia, nausea and vomiting, and epigastric pain, followed by signs of acute liver failure, such as encephalopathy and jaundice
.
Transaminase can rise up to 20 times
.
Coagulopathy can also be observed in AFLP and HELLP syndromes, caused by decreased AFLP synthesis and increased HELLP consumption
.
AFLP usually requires intensive care treatment
.
In most cases, immediate delivery is the first-line treatment, but laboratory and clinical abnormalities may last up to a week after delivery
.
Fetuses born to AFLP patients are at higher risk of liver failure, cardiomyopathy, nonketotic hypoglycemia, myopathy, and neuropathy
.
In addition, AFLP may recur in subsequent pregnancies
.
Liver diseases that may develop into pregnancy complications Chronic liver diseases that may be affected by pregnancy or exacerbated by pregnancy include AIH, PBC, PSC, and NAFLD
.
Autoimmune hepatitis AIH is a chronic inflammatory liver disease.
Histological examination shows that it is characterized by elevated transaminases, appearance of anti-nuclear or anti-smooth muscle antibodies, elevated IgG, and interface hepatitis/plasma-lymphocyte inflammation
.
Controlled AIH is not a contraindication to pregnancy, but women with liver cirrhosis are at the highest risk of adverse outcomes and require close monitoring
.
Regarding drug treatment, no significant relationship has been found between the use of immunosuppressants (corticosteroids and azathioprine) during pregnancy and adverse outcomes
.
In order to prevent possible adverse outcomes due to poor disease control, it is recommended to maintain immunosuppressive therapy, but mycophenolate mofetil is forbidden
.
Hepatitis may occur after delivery, so the mother should be closely monitored for at least six months after delivery
.
Primary biliary cholangitis and primary sclerosing cholangitis PBC and PSC are chronic cholestatic liver diseases
.
PBC may progress to liver cirrhosis and liver failure
.
Like AIH, PBC mainly occurs in middle-aged women, but it can also occur in young women
.
Pregnancy in patients with non-cirrhotic PBC is not associated with an increased risk of adverse maternal or fetal outcomes
.
However, due to the high risk of potential childbirth complications, pregnancy and childbirth must be closely monitored
.
About half of pregnant women with PBC may experience new itching or worsening of itching, and occasionally need anti-itch treatment
.
UDCA is safe and well tolerated by pregnant women and should not be discontinued
.
Bezafibrate is often used as a second-line treatment of PBC in Japan and is contraindicated during pregnancy
.
PSC mainly involves daring ducts inside and outside the liver
.
Unlike PBC, PSC is more common in men, with adolescents and young adults at the highest risk
.
Although 20% and 32% of patients have elevated liver enzymes during pregnancy and postpartum, respectively, the clinical course of PSC is not affected by pregnancy
.
Patients with PSC may experience new itching or worsening of itching
.
Although the available data are limited, the maternal and fetal prognosis of pregnant women with PBC and PSC is good, and it is recommended to closely monitor and treat possible pruritus
.
Non-alcoholic fatty liver disease NAFLD is the most common liver disease in women of childbearing age
.
Although data on the effects of NAFLD on the mother and fetus are scarce, several studies have shown that it has a negative impact on pregnancy outcomes
.
Gestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy, and its correlation with NAFLD is likely to be bidirectional
.
NAFLD in the first trimester is significantly associated with an increased risk of GDM, and previous GDM is also a predictor of postpartum NAFLD
.
In order to reduce the burden of NAFLD on the mother and fetus, it is extremely important to control prenatal hyperglycemia, prevent GDM, and avoid excessive weight gain during pregnancy
.
Literature index: Sasamori Y, Tanaka A, Ayabe T.
Liver disease in pregnancy.
Hepatol Res.
2020 Jun 24.
doi: 10.
1111/hepr.
13540.
