Multidisciplinary care is needed to ensure positive maternal and fetal health outcomes, especially in complex or high-risk cases.
Clinicians should be aware of how to manage certain gastrointestinal and liver conditions associated with pregnancy, such as hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, and acute fatty liver of pregnancy, according to a clinical practice update from the American Gastroenterological Association.
Once pregnant, though, patients shouldn’t be deterred from receiving procedures, medications, or interventions just because they’re pregnant, the authors wrote. Instead, taking an individual approach will help clinicians decide what to do based on the risks and benefits. For patients with IBD, clinical remission helps to improve pregnancy outcomes, including before conception, during pregnancy, and throughout the postpartum period. Biologic agents should be used during pregnancy and postpartum, though methotrexate, thalidomide, and ozanimod should be stopped at least 6 months before conception.
Other pregnancy-related liver diseases — such as pre-eclampsia; hemolysis, elevated liver enzymes, and low platelets syndrome; and acute fatty liver of pregnancy — require careful birth planning and evaluation for possible liver transplantation. For certain high-risk patients, daily aspirin should start at week 12 of gestation.
Pregnant Liver Biliary Disease Gallbladder Disease Liver Disease Hepatic Impairment Fatty Liver Steatorrhoeic Hepatosis Steatosis Hepatis Transplantation Of The Liver Hepatic Transplantation Liver Transplantation Aminotransferase Ast Liver Enzymes Liver Studies Alt Transaminase Nonalcoholic Fatty Liver Disease NAFLD Non-Alcoholic Fatty Liver Disease
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