Brady Carla W
Division of Gastroenterology Duke University Medical Center Durham NC.
Hepatol Commun. 2020 Jan 6;4(2):145-156. doi: 10.1002/hep4.1470. eCollection 2020 Feb.
Liver disease in pregnancy may present as a disorder that is unique to pregnancy or as an acute or chronic liver disease occurring coincidentally in pregnancy. Hepatic diseases that are unique to pregnancy include hyperemesis gravidarum; preeclampsia/eclampsia; the syndrome of hemolysis, elevated liver enzymes, and low platelets; intrahepatic cholestasis of pregnancy; and acute fatty liver of pregnancy. Acute and chronic forms of primary hepatic disorders that are seen in pregnancy include viral hepatitis, autoimmune hepatitis, nonalcoholic fatty liver disease, and cirrhosis. Because of the need to consider both maternal and fetal health, there are special considerations for the implementation of diagnostic strategies and pharmacologic therapies for liver disease that occurs in pregnancy. An understanding of the pathogenesis and expression of liver diseases in pregnancy has been evolving, and various diagnostic and prognostic tools have been studied in order to determine noninvasive approaches to identifying and staging of such diseases. Investigations have also been underway to evaluate the safety and utility of existing and new therapeutic agents that previously were thought to not be compatible with pregnancy. This review will explore updates in the epidemiology, diagnosis, and management of various liver diseases seen in pregnancy.
妊娠期肝病可能表现为妊娠期特有的疾病，也可能是妊娠期间偶然发生的急性或慢性肝病。妊娠期特有的肝病包括妊娠剧吐；先兆子痫/子痫；溶血、肝酶升高和血小板减少综合征；妊娠期肝内胆汁淤积症；以及妊娠急性脂肪肝。妊娠期间可见的原发性肝病的急性和慢性形式包括病毒性肝炎、自身免疫性肝炎、非酒精性脂肪性肝病和肝硬化。由于需要兼顾母体和胎儿的健康，对于妊娠期发生的肝病，在实施诊断策略和药物治疗时需要特别考虑。对妊娠期肝病的发病机制和表现的认识一直在不断发展，并且已经研究了各种诊断和预后工具，以确定识别和分期此类疾病的非侵入性方法。也一直在进行调查，以评估以前被认为与妊娠不相容的现有和新治疗药物的安全性和效用。本综述将探讨妊娠期各种肝病在流行病学、诊断和管理方面的最新进展。
