Department of Infectious Diseases, Nanjing Second Hospital, School of Medicine, Southeast University, Nanjing, China.
Department of Obstetrics & Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China.
Best Pract Res Clin Obstet Gynaecol. 2020 Oct;68:89-102. doi: 10.1016/j.bpobgyn.2020.02.012. Epub 2020 Mar 9.
Abnormal liver function tests during pregnancy are common. While hepatic injury during pregnancy mostly has minimal adverse influence on maternal and fetal outcomes, severe maternal and fetal morbidities, and even death, sometimes occur. Here, we review the epidemiology, clinical features, diagnosis, and management of hepatitis during pregnancy caused by the less common pathogens, including Epstein-Barr virus (EBV), cytomegalovirus (CMV), herpes simplex viruses (HSVs), dengue fever, malaria, leptospirosis, Q fever, typhoid fever, and other occasional infections, as well as the implications on breastfeeding of the infants. Hepatitis during pregnancy with fever and systemic clinical presentations, which are not attributable to the common infectious agents, should raise the suspicion of infection with above-mentioned pathogens, and appropriate laboratory tests are required. Early recognition of severe hepatitis or acute liver failure is critical in initiating appropriate and specific therapy, together with systemic supportive care, to reduce maternal and fetal mortality and long-term sequelae.
怀孕期间肝功能检查异常很常见。虽然妊娠期间肝损伤对母婴结局的不良影响通常较小，但有时也会出现严重的母婴并发症，甚至死亡。在这里，我们复习了由较少见病原体引起的妊娠相关肝炎的流行病学、临床特征、诊断和处理，包括 Epstein-Barr 病毒（EBV）、巨细胞病毒（CMV）、单纯疱疹病毒（HSV）、登革热、疟疾、钩端螺旋体病、Q 热、伤寒和其他偶发感染，以及对婴儿母乳喂养的影响。伴有发热和全身临床表现的妊娠相关肝炎，且不能归因于常见的感染病原体时，应怀疑感染上述病原体，需要进行适当的实验室检查。早期识别严重肝炎或急性肝衰竭对于启动适当和特异性治疗以及全身支持治疗以降低母婴死亡率和长期后遗症至关重要。
