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World J Gastroenterol. Nov 21, 2013; 19(43): 7630-7638
Published online Nov 21, 2013. doi: 10.3748/wjg.v19.i43.7630
Liver diseases in pregnancy: Diseases not unique to pregnancy
Ashraf A Almashhrawi, Khulood T Ahmed, Rubayat N Rahman, Ghassan M Hammoud, Jamal A Ibdah
Ashraf A Almashhrawi, Khulood T Ahmed, Rubayat N Rahman, Ghassan M Hammoud, Jamal A Ibdah, Division of Gastroenterology and Hepatology, University of Missouri-Columbia, Columbia, MO 65212, United States
Author contributions: Almashhrawi AA wrote and revised the manuscript; Ahmed KT, Rahman RN, and Hammoud GM were involved in reviewing the literature and collecting data; and Ibdah JA conceived the topic, contributed to the writing, analyzed and edited the manuscript, and provided overall intellectual input into the design and execution of the manuscript.
Correspondence to: Jamal A Ibdah, MD, PhD, Professor, Director, Division of Gastroenterology and Hepatology, University of Missouri-Columbia, 319 jesse hall, Columbia, MO 65212, United States. ibdahj@health.missouri.edu
Telephone: +1-573-8827349 Fax: +1-573-8844595
Received: June 10, 2013
Revised: August 5, 2013
Accepted: September 4, 2013
Published online: November 21, 2013
Abstract

Pregnancy is a special clinical state with several normal physiological changes that influence body organs including the liver. Liver disease can cause significant morbidity and mortality in both pregnant women and their infants. Few challenges arise in reaching an accurate diagnosis in light of such physiological changes. Laboratory test results should be carefully interpreted and the knowledge of what normal changes to expect is prudent to avoid clinical misjudgment. Other challenges entail the methods of treatment and their safety for both the mother and the baby. This review summarizes liver diseases that are not unique to pregnancy. We focus on viral hepatitis and its mode of transmission, diagnosis, effect on the pregnancy, the mother, the infant, treatment, and breast-feeding. Autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis, Wilson’s disease, Budd Chiari and portal vein thrombosis in pregnancy are also discussed. Pregnancy is rare in patients with cirrhosis because of the metabolic and hormonal changes associated with cirrhosis. Variceal bleeding can happen in up to 38% of cirrhotic pregnant women. Management of portal hypertension during pregnancy is discussed. Pregnancy increases the pathogenicity leading to an increase in the rate of gallstones. We discuss some of the interventions for gallstones in pregnancy if symptoms arise. Finally, we provide an overview of some of the options in managing hepatic adenomas and hepatocellular carcinoma during pregnancy.

Keywords: Liver, Pregnancy, Viral hepatitis, Autoimmune, Cirrhosis, Gallstones, Adenoma

Core tip: Pregnancy is a special clinical state with several normal physiological changes that influence body organs including the liver. Liver disease can cause significant morbidity and mortality in both pregnant women and their infants. Challenges involve making the diagnosis and the methods of treatment and their safety for both the mother and the baby. This review summarizes liver diseases that are not unique to pregnancy.