Sunday, 1 December 2013

Liver diseases in pregnancy - Preexisting liver diseases part - 2

Primary biliary cirrhosis: Ursodeoxycholic acid (FDA category B) at doses of 10 to 13 mg/kg is treatment of choice and may be continued during pregnancy and breastfeeding.

Autoimmune hepatitis:
The course is unpredictable. Corticosteroids are the treatment of choice.
Although azathioprine is in FDA category D (positive evidence of risk), we have little evidence that it is toxic in pregnancy (safe in pregnancy at dosages less than 100mg/day ).

Wilson's Disease:
A rare disorder characterized by cirrhosis, neurological abnormalities, and less commonly hematological and renal dysfunction.
D-Penicillamine and trientine have been used during pregnancy. However, the dosage should be minimum necessary dose, which is about 25% to 50% of the dose the patient had been taking before the pregnancy.
Zinc is the agent of choice for Wilson disease during pregnancy because of its safety for the fetus.
It should be maintained throughout the pregnancy at 50 mg three times a day.

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