Liver Disease and Pregnancy
In this podcast, Nancy S. Reau, MD, speaks about liver disease and pregnancy, including liver diseases that are unique to pregnancy, chronic diseases that impact pregnancy management, and how to recognize women who are at risk of liver disease during pregnancy.
Nancy S. Reau, MD, is the Chief of Hepatology and a transplant hepatologist at Rush University (Chicago, IL).
TRANSCRIPTION:
Jessica Bard: Hello, everyone, and welcome to another installment of Podcast360, your go-to resource for medical news and clinical updates. I'm your moderator, Jessica Bard with Consultant360, a multidisciplinary medical information network. Dr. Nancy Reau is here to speak with us today about her session at ACG 2022 titled, "Liver Disease and Pregnancy." Dr Reau is the chief of hepatology and a transplant hepatologist at Rush University Medical Center in Chicago, Illinois. Thank you for joining us today, Dr Reau. Can you please provide us with an overview of your session?
Dr Nancy Reau:This is a really unique session. First of all, it's a paired session. There's a component where the audience, for the bonus sessions, are pulled together and we're going to have a nice round table talking about some of the highline topics from our actual lecture. And then there's a bonus session that you can get to online. And my assignment was really to discuss liver diseases and pregnancy. And we recognize that there's really two main categories here. The first are really liver diseases that are unique to pregnancy, suggest the pregnancy itself is the responsibility for the liver disease, that this wouldn't have occurred in independent of pregnancy. And then there's nothing unique to a pregnant woman that allows them to be immune for chronic liver diseases or acute liver injury. And so, another component is talking not about all liver diseases that can occur to a pregnant woman, but really concentrating on those chronic diseases that impact pregnancy management.
Jessica Bard: Right. You mentioned recognizing liver diseases that are unique to pregnancy. Could you just elaborate and speak to that a little bit more, please?
Dr Nancy Reau: Yes. First of all, liver diseases unique to pregnancy are a really frightening event. They have a high risk of maternal and fetal morbidity and mortality if they're recognized late. But if you recognize them on time, pretty much every single one of them has effective management strategies. Even if it is to terminate the pregnancy, not sometimes early, but the child and the mother will often do great, as long as it's recognized and managed efficiently. And so, how to recognize a woman at risk, how to recognize those signs and symptoms, so you can have that early management and pull together that collaborative team that's going to support that mother child unit, that's really important and that's part of what the lecture is going to cover.
Jessica Bard: And then, you also mentioned chronic diseases that can impact pregnancy. What do you plan to speak about in your session?
Dr Nancy Reau: I think, firstly, it's important to recognize that pregnancy and cirrhosis is increasing. Now, we don't normally think of a cirrhotic woman as being able to get pregnant because most people assign cirrhosis to individuals that are older and really, really sick. But if you think about the two main reasons for liver disease in the United States, and that's alcoholic hepatitis and non-alcohol related fatty liver disease, these are occurring in younger and younger populations. And although NAFLD is very common and uncommonly leads to advanced disease, if you imagine that a third of America has fatty liver disease, and even a small portion ends up with more aggressive advanced disease, that's still a lot of individuals.
More frighteningly, alcoholic hepatitis will often present with cirrhosis, so these young people present with alcoholic hepatitis. And if you look carefully at their liver tissue, we'll find that there's a lot of scar tissue, enough to label them as cirrhotic, and these individuals are often very young. If you have someone who's got very well compensated liver disease. So, even with cirrhosis, if the liver function is good and they don't have symptoms of liver disease, they often have good fertility. And even if they have marginal fertility, IVF, or the fertility options do still allow viable pregnancies in this population. And they are high risk group of individuals. They have a risk of decompensating liver disease, of portal hypertension. And so, it's really important to recognize these women that have potential risk, but may not scream, "Hey, I have underlying liver disease" in front of you, and know how to proactively manage them.
Jessica Bard: What would you say would be the biggest take-home messages from your session for maybe an OBGYN audience? And we do know that there are some new guidelines that the ACG presented that could be a great resource.
Dr Nancy Reau: Yeah. I think the most important thing from an OBGYN perspective is really collaboration. And I think that's kind of where these guidelines come in. ACOG and maternal fetal medicine have excellent guidelines. But the America College of Gastroenterology just published a monograph that's across all of the GI spectrum. Not just liver diseases, but also luminal GI talking about immune suppression, IBD, even common things like reflux disease and pregnancy. And so, that's a really great resource. On top of that, the American Association for the Study of Liver Disease or AASLD, I think last year put out very comprehensive guidelines for all features of reproductive health, that covers not just liver diseases that can be caused by pregnancy and chronic liver diseases, but also discusses some of the reproductive health, such as choices of oral contraception in patients with liver disease, management of benign tumors. So, it's a very comprehensive guidance and very nice tool for someone who's looking for additional resource.
Jessica Bard: And then, what would you say are the overall take-home messages from our conversation today and from your session, really, just for any clinician leaving your presentation?
Dr Nancy Reau: I think that the most important thing is to recognize that pregnancy is a scary thing and liver disease is a scary thing. And when you put the two together, that's often a very frightened mother, a very frightened family, and a very frightened clinician. And so, the hope is that the session will really lead to some tools for early recognition, and how to co-manage these patients, so that it takes a little bit of fear out of something that is often overwhelming. Thankfully, most of us do not see liver-related injury in pregnancy on a daily basis. That is reassuring. But it also makes it a little more nerve-wracking when you do actually encounter it. So, hopefully the session will take a little bit of angst out of that.
Jessica Bard: Thank you so much for joining us on the podcast. Is there anything else that you'd like to add?
Dr Nancy Reau: No, other than your friendly hepatologist is always a great consultant. And I think reaching across and asking those questions at a earlier time point, there is no question that's stupid. We say that over and over again, but we actually mean that. And so, if you're wondering about something or you're uncomfortable reaching out at an earlier time point, it's always more effective than waiting until it's obvious that you needed to help with the hepatologist.
Jessica Bard: Well, thank you again for joining us.
Dr Nancy Reau: Oh, thank you for asking me