WOMEN

Pregnancy and Liver Function

How does pregnancy affect the liver?
Pregnancy has little effect on a normal liver. There are no significant changes in liver function during pregnancy, but some markers of liver function may alter slightly. For example, alkaline phosphatase may go up modestly as the pregnancy advances, due to its production by a normal placenta. Blood levels of albumin will decrease because of the dilution of an expectant mother’s blood. However, any abnormalities in standard tests (bilirubin, aminotransferase, or protime) should be considered an indication of possible liver problems.

Why do some pregnant women experience jaundice?
The onset of jaundice during pregnancy is usually related to impaired bile flow. In susceptible individuals, the liver’s ability to handle bile acids may change during pregnancy, due to the effects of estrogen, which increases during pregnancy. In general, there are no lasting consequences for the mother, but there is an increased risk of premature birth or stillbirth for the baby in affected pregnancies. All pregnant women with jaundice must undergo evaluation by a physician to determine the cause of their jaundice.

What effect does toxemia have on the liver?
Toxemia is a common disorder of late pregnancy. It includes high blood pressure, leg swelling or edema, and kidney dysfunction. In approximately 10% of women with toxemia, the liver is also affected. Blood clots form, and there is bleeding into the liver. In severe cases, this can be life threatening. In mild cases, liver function remains normal even though liver blood tests may be abnormal.

What is HELLP syndrome?
The HELLP Syndrome (Hemolysis, Elevated Liver enzyme levels and Low Patelet count) is part of the liver disease that affects women with toxemia. Its name is derived from abbreviations for hemolysis (the breakdown of red blood cells), elevated liver tests, and low platelets in the blood. The disease stops with delivery, and the liver generally heals itself within weeks. During the active stages of the disease, the mother is a risk of liver damage and bleeding, and the baby risks premature delivery or stillbirth.

What is the affect of alcohol on a pregnant woman's liver?
Moderate alcohol consumption (one or two drinks daily) probably does not affect the liver of an otherwise normal pregnant woman, but even moderate doses may cause damage to the fetus.

Hepatitis -  C – Information for Pregnant Women

If my baby is infected, how serious is it?

• Most babies who get hepatitis C from their mothers are not able to get rid of the virus, and many infected babies go on to develop chronic inflammation of the liver.
• HCV positive babies may grow normally and feel well for many years. However, they are at

risk of developing scarring of the liver, also known as cirrhosis, many years later. A small proportion of those who develop cirrhosis may also get cancer of the liver.

What kind of care should my child get if she/he has
hepatitis C?

• A regular follow-up with a doctor experienced in dealing with hepatitis C, for example a gastroenterologist, hepatologist or infectious disease specialist may be desirable.

• Infectious precautions should be taken, such as avoidance of donating blood or sharing toothbrushes and needles.

• For those with more advanced cases of hepatitis C, there are treatments with medications such as alpha-interferon and ribavirin. However, experience with these medications in children is limited.

What is hepatitis C?

• Hepatitis C is a liver disease caused by a virus first identified in 1989. Hepatitis C virus, or HCV for short, is spread mainly when people share blood or body fluids containing blood.
• Hepatitis C is different from hepatitis A and hepatitis B.

How does someone get hepatitis C?

• Injection drug use is the most common way of getting hepatitis C. Less commonly, tattooing, body piercing, or acupuncture in less-than-sterile conditions, or sharing a toothbrush or razor with an infected person can spread the virus.
• Although transmission of hepatitis C from unprotected sex is rare, it is not absent. The risk increases when there are open sores and during menstrual periods. Safe sex should be practised at all times to minimize acquiring other infections.

• A pregnant woman can just as easily get infected through all the routes mentioned above.

If I have hepatitis C and get pregnant, can I pass it on to my baby?

• The risk of HCV transmission to the baby is low compared to other viruses such as hepatitis B or HIV. Approximately 5 out of 100 mothers who have HCV might pass it to their babies before or at the time of birth.
• If a mother has both hepatitis C and HIV, the risk of the baby getting hepatitis C is much higher than when the mother is infected with hepatitis C alone. Anywhere from 22 to 36 out of 100 babies born to hepatitis C and HIV positive mothers will become infected with hepatitis C.

How will I know if my baby is infected with HCV?

• There are two main blood tests used to diagnose hepatitis C. Hepatitis C antibody test, which is

used to diagnose the infection in adults, is not useful in infants because their mother’s antibodies
that are passively passed on to them during pregnancy persist until they are 18 months of age.

• The diagnosis in a baby is made using a test called hepatitis C RNA, which examines the baby’s blood directly for the presence of the actual viral material of HCV. Although this test is very good, it may take several months after birth for the virus count in the baby’s blood to rise high enough for detection. Repeated testing in the first year of baby’s life is often necessary before the diagnosis can be made.

Can I breastfeed my baby safely?

• HCV has been found in breast milk infrequently, and the studies so far do not show that breastfeeding increases the risk of transmission of hepatitis C to the baby. Therefore, the baby CAN be safely breastfed.

• However, if the nipples are bleeding or cracked, it is recommended that breastfeeding be stopped until they are healed.

Can I do anything to reduce the risk of passing it to my baby?

• Unfortunately, there is currently no effective way to prevent or reduce the risk of hepatitis C transmission to the baby.

• The mode of delivery (caesarean or vaginal) does not seem to affect the rate of transmission, but firm evidence is lacking.

• However, for mothers infected with both hepatitis C and HIV, there are medications that can significantly reduce the risk of passing HIV to the baby.

Will pregnancy make my hepatitis C worse?

• Most HCV positive mothers do not have any symptoms when they are pregnant.
• The markers in blood for the activity of HCV such as liver tests or the amount of virus count

remain low in pregnancy in general, but tend to increase slightly after the birth of the baby.
However, symptomatic liver disease is still rare even in the postpartum period.

Liver Disease in Women - Summit

Description

Gender differences regarding liver disease abound. Liver diseases associated with pregnancy or use of oral contraceptives, of course, occur only in women, and women have a preponderance of primary biliary cirrhosis and autoimmune hepatitis. Even liver diseases without a female preponderance, such as hepatitis B and C, pose distinctive problems in women.

Women infected with hepatitis B play a central role in the perpetuation of this viral infection through vertical transmission. Most cases of cirrhosis are secondary to chronic alcohol abuse. Women are more susceptible to developing alcohol-induced liver disease, often have more advanced liver disease at diagnosis, and have worse outcomes.

Research has not sufficiently explored the differential effects of liver diseases in women and the specific issues they pose to women regarding prevention, diagnosis, and treatment. Few, if any, national conferences have attempted to assemble major stakeholders, including clinicians, researchers, and industry representatives, to review female-related liver disease topics. This Summit on Liver Disease in Women will address an array of gender-related issues in liver disease:

• Explore biological explanations for liver disease in women;
• Outline specific health-related issues for women with liver disease;
• Define key management and counseling issues regarding prevention, containment, and transmission of liver disease in women, especially as they pertain to sexuality issues;
• Identify optimal treatment strategies for liver disease and related complications in women; and
• Establish a relevant research agenda for liver disease in women.

Target Audience

The Summit will be directed to gastroenterologists, hepatologists, internists, family practice physicians, nurse practitioners, nurses, physician assistants, and other health care professionals interested in women’s health and liver disease.

Objectives

As a result of attending this course, the participant will be able to:

• Realize the gender differences in the biology, immunobiology, and metabolism of drugs and toxins.
• Determine the pathophysiology and management of liver diseases that affect women more commonly than men such as autoimmune hepatitis, primary biliary cirrhosis, and non-alcoholic fatty liver disease.
• Predict how liver transplantation affects fertility, sexuality, quality of life, and other medical conditions such as diabetes and bone loss in women.
• Describe how certain disorders specific to women such as pregnancy, hormonal replacement therapy, and sensitivity to alcohol affect the liver in women.
• Evaluate the consequences of viral hepatitis in women and how to target high-risk populations and immigrants.

To read more view PDF:
https://www.clevelandclinicmeded.com/ASPCL01B/LiverDisease07/LiverDisease07.pdf