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PREGNANCY ASSOCIATED HEPATOBILIARY DYSFUNCTION

Published online by Cambridge University Press:  02 August 2016

ABHA KAUL ,
BASKY THILAGANATHAN  and
TONY RAHMAN
ABHA KAUL*
Affiliation:
Departments of Gastroenterology, The Prince Charles Hospital, Rode Road, Chermside, Brisbane 4032, Australia
BASKY THILAGANATHAN
Affiliation:
Foetal-Maternal Unit, Academic Department of Fetal Medicine, Obstetrics & Gynaecology, St George's, University of London, Cranmer Terrace, London, SW17 8QT, UK
TONY RAHMAN
Affiliation:
Departments of Gastroenterology, The Prince Charles Hospital, Rode Road, Chermside, Brisbane 4032, Australia Department of Medicine & Dentistry, James Cook University, Cairns, Australia
*
Abha Kaul, M. B. B. S. Departments of Gastroenterology, The Prince Charles Hospital, Rode Road, Chermside, Brisbane 4032, Australia. Email: [email protected]
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Extract

Physiological changes associated with pregnancy are well documented, the liver is no exception. Changes to maternal physiology during pregnancy can give rise to a change in liver function tests.

Type
Review Article
Information
Fetal and Maternal Medicine Review , Volume 25 , Issue 3-4 , November 2014 , pp. 318 - 331
Copyright
Copyright © Cambridge University Press 2016 

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References

1. Rolfes, D, Ishak, K. Liver disease in pregnancy. Histopathol 1986; 10 (6): 555–70.CrossRefGoogle ScholarPubMed
2. Hellgren, M editor. Hemostasis during normal pregnancy and puerperium. Seminars in Thrombosis and Hemostasis. New York: Stratton Intercontinental Medical Book Corporation; 2003; 29 (2):125–30.Google Scholar
3. Lammert, F, Marschall, H-U, Glantz, A, Matern, S. Intrahepatic cholestasis of pregnancy: molecular pathogenesis, diagnosis and management. J Hepatol 2000; 33 (6): 1012–21.Google Scholar
4. Lee, R, Goodwin, T, Greenspoon, J, Incerpi, M. The prevalence of intrahepatic cholestasis of pregnancy in a primarily Latina Los Angeles population. J Perinatol 2006; 26 (9): 527–32.CrossRefGoogle Scholar
5. Reyes, H. Review: intrahepatic cholestasis. A puzzling disorder of pregnancy. J Gastroenterol. Hepatol 1997; 12 (3): 211–6.Google Scholar
6. Reyes, H, Báez, ME, González, MC, Hernández, I, Palma, J, Ribalta, J et al. Selenium, zinc and copper plasma levels in intrahepatic cholestasis of pregnancy, in normal pregnancies and in healthy individuals, in Chile. J Hepatol 2000; 32 (4): 542–9.CrossRefGoogle ScholarPubMed
7. Berg, B, Helm, G, Petersohn, L, Tryding, N. Cholestasis of pregnancy: clinical and laboratory studies. Acta Obstet Gynecol Scand 1986; 65 (2): 107–13.Google Scholar
8. Dixon, P, Williamson, C. The molecular genetics of intrahepatic cholestasis of pregnancy. Obstet Med: Med Pregnancy 2008; 1 (2): 65–71.Google Scholar
9. Schneider, G, Paus, TC, Kullak-Ublick, GA, Meier, PJ, Wienker, TF, Lang, T et al. Linkage between a new splicing site mutation in the MDR3 alias ABCB4 gene and intrahepatic cholestasis of pregnancy. Hepatol 2007; 45 (1): 150–8.Google Scholar
10. Floreani, A, Carderi, I, Paternoster, D, Soardo, G, Azzaroli, F, Esposito, W et al. Intrahepatic cholestasis of pregnancy: three novel MDR3 gene mutations. Aliment Pharmacol Ther 2006; 23 (11): 1649–53.CrossRefGoogle ScholarPubMed
11. Johnson, P, Samsioe, G, Gustafson, A. Studies in cholestasis of pregnancy. Acta Obstet Gynecol Scand 1975; 54 (1): 77–84.Google Scholar
12. Glantz, A, Marschall, HU, Mattsson, LÅ. Intrahepatic cholestasis of pregnancy: relationships between bile acid levels and fetal complication rates. Hepatol 2004; 40 (2): 467–74.Google Scholar
13. Binder, T, Salaj, P, Zima, T, Vítek, L. Randomized prospective comparative study of ursodeoxycholic acid and S-adenosyl-L-methionine in the treatment of intrahepatic cholestasis of pregnancy. J Perinatal Medi 2006; 34 (5): 383–91.Google Scholar
14. Glantz, A, Marschall, HU, Lammert, F, Mattsson, LÅ. Intrahepatic cholestasis of pregnancy: a randomized controlled trial comparing dexamethasone and ursodeoxycholic acid. Hepatol 2005; 42 (6): 1399–405.Google Scholar
15. Sentilhes, L, Verspyck, E, Pia, P, Marpeau, L. Fetal death in a patient with intrahepatic cholestasis of pregnancy. Obstet Gynecol 2006; 107 (2, Part 2): 458–60.Google Scholar
16. Kondrackiene, J, Beuers, U, Kupcinskas, L. Efficacy and safety of ursodeoxycholic acid versus cholestyramine in intrahepatic cholestasis of pregnancy. Gastroenterology 2005; 129 (3): 894–901.Google Scholar
17. Mazzella, G, Nicola, R, Francesco, A, Patrizia, S, Luciano, B, Anna, M et al. Ursodeoxycholic acid administration in patients with cholestasis of pregnancy: effects on primary bile acids in babies and mothers. Hepatol 2001; 33 (3): 504–8.Google Scholar
18. Williamson, C, Hems, LM, Goulis, DG, Walker, I, Chambers, J, Donaldson, O et al. Clinical outcome in a series of cases of obstetric cholestasis identified via a patient support group. BJOG: Int J Obstet Gynaecol 2004; 111 (7): 676–81.Google Scholar
19. IJlst, L, Oostheim, W, Ruitter, J, Wanders, R. Molecular basis of long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency: identification of two new mutations. J Inherit Metab Dis 1997; 20 (3): 420–22.CrossRefGoogle ScholarPubMed
20. Sibai, BM. Diagnosis and management of gestational hypertension and preeclampsia. Obstet Gynecol 2003; 102 (1): 181–92.Google Scholar
21. Guntupalli, SR, Steingrub, J. Hepatic disease and pregnancy: an overview of diagnosis and management. Crit Care Med 2005; 33 (10): S332–S9.Google Scholar
22. Caniggia, I, Winter, J, Lye, S, Post, M. Oxygen and placental development during the first trimester: implications for the pathophysiology of pre-eclampsia. Placenta 2000; 21: S25–S30.Google Scholar
23. Walsh, S, Vaughan, J, Wang, Y, Roberts, L. Placental isoprostane is significantly increased in preeclampsia. FASEB J 2000; 14 (10): 1289–96.Google Scholar
24. Stepan, H, Herraiz, I, Schlembach, D, Verlohren, S, Brennecke, S, Chantraine, F et al. Implementation of the sFlt-1/PlGF ratio for prediction and diagnosis of pre-eclampsia in singleton pregnancy: implications for clinical practice. Ultrasound Obstet Gynecol 2015; 45 (3): 241–46.Google Scholar
25. Murphy, DJ, Stirrat, GM. Mortality and morbidity associated with early-onset preeclampsia. Hypertens Pregnancy 2000; 19 (2): 221–31.Google Scholar
26. Sibai, BM, Ramadan, MK, Usta, I, Salama, M, Mercer, BM, Friedman, SA. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). Am J Obstet Gynecol 1993; 169 (4): 1000–6.Google Scholar
27. Magann, EF, Jr, Martin JN. Twelve steps to optimal management of HELLP syndrome. Clin Obstet Gynecol 1999; 42 (3): 532.Google Scholar
28. Sibai, BM, Mercer, BM, Schiff, E, Friedman, SA. Aggressive versus expectant management of severe preeclampsia at 28 to 32 weeks' gestation: a randomized controlled trial. Am J Obstet Gynecol 1994; 171 (3): 818–22.Google Scholar
29. Cavkaytar, S, Ugurlu, EN, Karaer, A, Tapisiz, OL, Danisman, N. Are clinical symptoms more predictive than laboratory parameters for adverse maternal outcome in HELLP syndrome? Acta Obstet Gynecol Scand 2007; 86 (6): 648–51.Google Scholar
30. Sibai, BM, Caritis, S, Hauth, J, Health NIoC, Network HDM-FMU, editors. What we have learned about preeclampsia. Seminars in Perinatology 2003; 27 (3).Google Scholar
31. O'Brien, JM, Barton, JR. Controversies with the diagnosis and management of HELLP syndrome. Clin Obstet Gynecol 2005; 48 (2): 460–77.Google Scholar
32. Fonseca, JE, Méndez, F, Cataño, C, Arias, F. Dexamethasone treatment does not improve the outcome of women with HELLP syndrome: a double-blind, placebo-controlled, randomized clinical trial. Am J Obstet Gynecol 2005; 193 (5): 1591–8.Google Scholar
33. Magann, EF, Bass, D, Chauhan, SP, Sullivan, DL, Martin, RW, Martin, JN. Antepartum corticosteroids: disease stabilization in patients with the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP). Am J Obstet Gynecol 1994; 171 (4): 1148–53.Google Scholar
34. Magann, EF, Perry, KG, Meydrech, EF, Harris, RL, Chauhan, SP, Martin, JN. Postpartum corticosteroids: accelerated recovery from the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP). Am J Obstet Gynecol 1994; 171 (4): 1154–8.Google Scholar
35. Isler, CM, Barrilleaux, PS, Magann, EF, Bass, JD, Martin, JN. A prospective, randomized trial comparing the efficacy of dexamethasone and betamethasone for the treatment of antepartum HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Am J Obstet Gynecol 2001; 184 (7): 1332–9.Google Scholar
36. Shames, BD, Fernandez, LA, Sollinger, HW, Chin, LT, D'Alessandro, AM, Knechtle, SJ et al. Liver transplantation for HELLP syndrome. Liver Transpl 2005; 11 (2): 224–8.Google Scholar
37. Sibai, BM, Ramadan, MK, Chri, RS, Friedman, SA. Pregnancies complicated by HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): subsequent pregnancy outcome and long-term prognosis. Am J Obstet Gynecol 1995; 172 (1): 125–9.Google Scholar
38. Gul, A, Cebeci, A, Aslan, H, Polat, I, Ozdemir, A, Ceylan, Y. Perinatal outcomes in severe preeclampsia-eclampsia with and without HELLP syndrome. Gynecol Obstet Invest 2004; 59 (2): 113–8.CrossRefGoogle ScholarPubMed
39. Osmanağaoğlu, MA, Erdoğan, İ, Zengin, Ü, Bozkaya, H. Comparison between HELLP syndrome, chronic hypertension, and superimposed preeclampsia on chronic hypertension without HELLP syndrome. J Perinat Med 2004; 32 (6): 481–5.Google Scholar
40. Knight, M, Nelson-Piercy, C, Kurinczuk, JJ, Spark, P, Brocklehurst, P. A prospective national study of acute fatty liver of pregnancy in the UK. Gut 2008; 57 (7): 951–6.Google Scholar
41. Ibdah, JA, Bennett, MJ, Rinaldo, P, Zhao, Y, Gibson, B, Sims, HF et al. A fetal fatty-acid oxidation disorder as a cause of liver disease in pregnant women. N Engl J Med 1999; 340 (22): 1723–31.Google Scholar
42. Yang, Z, Yamada, J, Zhao, Y, Strauss, AW, Ibdah, JA. Prospective screening for pediatric mitochondrial trifunctional protein defects in pregnancies complicated by liver disease. Jama 2002; 288 (17): 2163–6.Google Scholar
43. Castro, MA, Fassett, MJ, Reynolds, TB, Shaw, KJ, Goodwin, TM. Reversible peripartum liver failure: a new perspective on the diagnosis, treatment, and cause of acute fatty liver of pregnancy, based on 28 consecutive cases. Am J Obstet Gynecol 1999; 181 (2): 389–95.Google Scholar
44. Rajasri, A, Srestha, R, Mitchell, J. Acute fatty liver of pregnancy (AFLP)-an overview. J Obstet Gynecol 2007; 27 (3): 237–40.Google Scholar
45. Sebire, N, Jolly, M, Harris, J, Regan, L, Robinson, S. Is maternal underweight really a risk factor for adverse pregnancy outcome? A population-based study in London. Br J Obstet Gynaecol 2001; 108 (1): 61–6.Google Scholar
46. Sebire, NJ, Jolly, M, Harris, J, Wadsworth, J, Joffe, M, Beard, R et al. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord 2001; 25 (8): 1175–82.CrossRefGoogle Scholar
47. Ko, HH, Yoshida, E. Acute fatty liver of pregnancy. Can J Gastroenterol 2006; 20 (1): 25.Google Scholar
48. Bacq, Y, Assor, P, Gendrot, C, Perrotin, F, Scotto, B, Andres, C. Recurrent acute fatty liver of pregnancy. Gastroenterol Clin Biol 2007; 31 (12): 1135–8.Google Scholar
49. Wang, J, Zhu, Q, Zhang, X. Effect of delivery mode on maternal-infant transmission of hepatitis B virus by immunoprophylaxis. Chin Med J 2002; 115 (10): 1510–2.Google Scholar
50. Lee, C, Gong, Y, Brok, J, Boxall, EH, Gluud, C. Effect of hepatitis B immunisation in newborn infants of mothers positive for hepatitis B surface antigen: systematic review and meta-analysis. Bmj 2006; 332 (7537): 328–36.Google Scholar
51. Liver EAFTSOT. EASL clinical practice guidelines: management of chronic hepatitis B. J Hepatol 2009; 50 (2): 227–42.Google Scholar
52. Han, G-R, Cao, M-K, Zhao, W, Jiang, H-X, Wang, C-M, Bai, S-F et al. A prospective and open-label study for the efficacy and safety of telbivudine in pregnancy for the prevention of perinatal transmission of hepatitis B virus infection. J Hepatol 2011; 55 (6): 1215–21.Google Scholar
53. Bhattacharya, S, O'Donnell, K, Dudley, T, Kennefick, A, Osman, H, Boxall, E et al. Ante-natal screening and post-natal follow-up of hepatitis B in the West Midlands of England. QJM 2008; 101 (4): 307–12.Google Scholar
54. McMenamin, MB, Jackson, AD, Lambert, J, Hall, W, Butler, K, Coulter-Smith, S et al. Obstetric management of hepatitis C-positive mothers: analysis of vertical transmission in 559 mother-infant pairs. Am J Obstet Gynecol 2008; 199 (3): 315. e1–e5.Google Scholar
55. Gonzalez, F, Medam-Djomo, M-A, Lucidarme, D, Khalil, A, Decoster, A, de L'Aulnoit, DH et al. Acute hepatitis C during the third trimester of pregnancy. Gastroenterol Clin Biologique 2006; 30 (5): 786–9.Google Scholar
56. Özaslan, E, Yılmaz, R, Simsek, H, Tatar, G. Interferon therapy for acute hepatitis C during pregnancy. Ann Pharmacother 2002; 36 (11): 1715–8.Google Scholar
57. Elinav, E, Ben–Dov, IZ, Shapira, Y, Daudi, N, Adler, R, Shouval, D et al. Acute hepatitis a infection in pregnancy is associated with high rates of gestational complications and preterm labor. Gastroenterol 2006; 130 (4): 1129–34.Google Scholar
58. Mushahwar, IK. Hepatitis E virus: molecular virology, clinical features, diagnosis, transmission, epidemiology, and prevention. J Med Virology 2008; 80 (4): 646–58.Google Scholar
59. Khuroo, MS, Teli, MR, Skidmore, S, Sofi, MA, Khuroo, MI. Incidence and severity of viral hepatitis in pregnancy. Am J Med 1981; 70 (2): 252–5.Google Scholar
60. Tandon, B, Joshi, Y, Jain, S, Gandhi, B, Mathiesen, L, Tandon, H. An epidemic of non-A non-B hepatitis in north India. Indian J Med Res 2012 Nov 1; 136 (5).Google Scholar
61. Sreenivasan, M, Banerjee, K, Pandya, P, Kotak, R, Pandya, P, Desai, N et al. Epidemiological investigations of an outbreak of infectious hepatitis in Ahmedabad city during 1975–76. Indian J Med Res 1978; 67: 197–206.Google Scholar
62. Khuroo, M, Kamili, S. Aetiology, clinical course and outcome of sporadic acute viral hepatitis in pregnancy*. J Viral Hepat 2003; 10 (1): 61–9.Google Scholar
63. Navaneethan, U, Al Mohajer, M, Shata, MT. Hepatitis E and pregnancy: understanding the pathogenesis. Liver Int 2008; 28 (9): 1190–9.Google Scholar
64. Devarbhavi, H, Kremers, WK, Dierkhising, R, Padmanabhan, L. Pregnancy-associated acute liver disease and acute viral hepatitis: differentiation, course and outcome. J Hepatol 2008; 49 (6): 930–5.Google Scholar
65. Schramm, C, Herkel, J, Beuers, U, Kanzler, S, Galle, PR, Lohse, AW. Pregnancy in autoimmune hepatitis: outcome and risk factors. Am J Gastroenterol 2006; 101 (3): 556–60.Google Scholar
66. Heneghan, M, Norris, S, O'grady, J, Harrison, P, McFarlane, I. Management and outcome of pregnancy in autoimmune hepatitis. Gut 2001; 48 (1): 97–102.Google Scholar
67. Poupon, R, Chrétien, Y, Chazouillères, O, Poupon, RE. Pregnancy in women with ursodeoxycholic acid-treated primary biliary cirrhosis. J Hepatol 2005; 42 (3): 418–9.Google Scholar
68. Janczewska, I, Olsson, R, Hultcrantz, R, Broome, U. Pregnancy in patients with primary sclerosing cholangitis. Liver 1996; 16 (5): 326–30.Google Scholar
69. Steven, M, Buckley, J, Mackay, I. Pregnancy in chronic active hepatitis. QJM 1979; 48 (4): 519–31.Google ScholarPubMed
70. Aggarwal, N, Sawnhey, H, Suril, V, Vasishta, K, Jha, M, Dhiman, R. Pregnancy and cirrhosis of the liver. Aust N Z J Obstet Gynaecol 1999; 39 (4): 503–6.Google Scholar
71. Steven, M. Pregnancy and liver disease. Gut 1981; 22 (7): 592–614.Google Scholar
72. Hay, JE. Liver disease in pregnancy. Hepatol 2008; 47 (3): 1067–76.Google Scholar
73. Christopher, V, Al-Chalabi, T, Richardson, PD, Muiesan, P, Rela, M, Heaton, ND et al. Pregnancy outcome after liver transplantation: a single-center experience of 71 pregnancies in 45 recipients. Liver Transpl 2006; 12 (7): 1138–43.Google Scholar
74. Murthy, SK, Heathcote, EJ, Nguyen, GC. Impact of cirrhosis and liver transplant on maternal health during labor and delivery. Clin Gastroenterol Hepatol 2009; 7 (12): 1367–72. e1.Google Scholar