Spectrum of Liver – GI disorders in Pregnancy

Sujata Dalvi¹

Consultant Obstetricians and Gynecologist—Mumbai. Global/ Saifee/Bhatia/St. Elizabeth/Ruxmani—Jain Hospitals. Hon Clinical Associate. Nowrosjee Wadia Maternity/Jagjivan Ram Railway Hospital. Joint Associate Editor of JOGI (Journal of Obstetrics and Gynecology of India). Clinical Secretary Mumbai Obstetrics and Gynecological Society. Secretary AMOGS—Association of Maharashtra Obstetrics & Gynecological Societies.

Sujata Dalvi sujata.dalvi@hotmail.com 1 Nowrosjee Wadia Maternity Hospital, Mumbai, India

Pregnant women are affected by Gastro-intestinal and Liver disorders. These are related or not related to pregnancy. Unrelated conditions are pre-existent or co incidental during pregnancy. Pregnancy may promote symptoms / alter course of new or pre-existing disease resulting in complications only during pregnancy. This in turn can have adverse effect on clinical course affecting mother and fetus. The management remains same but its effect on mother and fetus needs to be kept in mind with pro-active treatment. Severe liver diseases though rare during pregnancy can occasionally be life threatening. Pregnancy after bariatric surgery / liver transplant is possible but with thorough counselling and needs multidisciplinary approach. Endoscopy for GI problems, if required can be carried out by Gastroenterologist with special attention. Hence, this article, for quick reference to tackle GI and Liver disorders in pregnancy.

Keywords : Gastro-intestinal · Liver · Pregnancy

Gastrointestinal and liver disorders occurring in woman of reproductive age group are mostly benign and remain unaffected during pregnancy. Some disorders may occur during pregnancy, but it does not change the management and outcome [1]. Disorders like Hepatitis E could be life threatening in pregnancy which would have benign course otherwise [2]. Gastroesophageal reflux, constipation could be bothersome, hyperemesis worrisome and obstetric cholestasis, acute fatty liver, HELLP syndrome could be fatal. Pregnancy after bariatric surgery or liver transplant need multidisciplinary approach.

Gastro‑intestinal System

Gastro-intestinal discomfort is common during pregnancy, most will experience at least one of them. Some may develop GI issues after pregnancy. Those with chronic GI issues can feel worsening of symptoms during pregnancy and need special attention. The commonest being nausea, vomiting, hyperemesis, gastrointestinal reflux (GERD), diarrhea—constipation, gall stones, colitis and irritable bowel syndrome (IBS). Certain disease like acute fatty liver of pregnancy develops only during pregnancy requiring urgent attention and delivery of fetus. Management of IBD with possibility of endoscopy needs special intervention by gastroenterologists. Hence this mini review article that can be referred quickly for proper management of GI and liver disorders in pregnancy.

Diseases During Pregnancy

GI complaints during pregnancy—nausea, vomiting, GI reflux, constipation. GI disorders unique to pregnancy— hyperemesis, intra-hepatic cholestasis, PIH with HELLP syndrome, acute fatty liver of pregnancy. Disorder exacerbated during pregnancy—Inflammatory Bowel Disease (IBD), Hepatitis E, physiological changes during pregnancy— hemodilution leads to decrease in hemoglobin/albumin. Alkaline phosphatase increases due to placental production, however aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), bilirubin and prothrombin time (PT) remain normal. Clotting factor changes make pregnancy a pro coagulation entity. Elevated levels of Progesterone lead to delayed gastric emptying time and high production of gastrin to acidity.

Careful history/physical examination is important to identify underlying drug induced hepatic impairment before presuming liver dysfunction to be secondary to pregnancy.

Declarations

Conflict of interest There is no conflict of interest with publication of manuscript or an Institution or product that is mentioned in the manuscript and/or is important to outcome of study presented.

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