AGA: ‘Keep both patient and fetus safe’ when managing GI, liver diseases in pregnancy
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Key takeaways:
- Procedures, medications and other interventions should be individualized based on an assessment of risks and benefits.
- Immunosuppressive therapy should be continued at the lowest possible dose.
Multidisciplinary care is key when managing patients with pregnancy-related gastrointestinal and liver diseases, with a “paramount goal” of keeping both the patient and the fetus safe, according to an AGA clinical practice update.
“Pregnancy-related morbidity and mortality are increasing in the United States, particularly for pregnancies that are considered high risk because of chronic or newly diagnosed medical comorbidities,” Shivangi Kothari, MD, assistant professor of medicine and associate director of endoscopy at University of Rochester Medical Center, and colleagues wrote in Gastroenterology. “Recognizing a worsening disease course, triaging the level of maternal health and prescribing appropriate medication and interventions are essential.”
The AGA Institute Clinical Practice Updates Committee and governing board commissioned this expert review to “provide timely guidance” and practical advice for the management of pregnant patients with GI and liver diseases — a topic of “high clinical importance” to AGA membership.
Experts developed 13 best practice advice statements based on published evidence and expert opinion, and noted the statements do not carry formal ratings regarding the quality or strength of evidence, as formal systematic reviews were not performed.
Highlights from the statements include:
- Procedures, medications and other interventions should not be withheld solely due to pregnancy but should be individualized following an assessment of risks and benefits.
- Early treatment of nausea and vomiting in pregnancy may reduce progression to hyperemesis gravidarum; treatment may include IV glucocorticoids in moderate to severe cases.
- Constipation may result from hormonal, medication-related and physiological changes; treatment may include dietary fiber, lactulose and polyethylene glycol-based laxatives.
- In patients with inflammatory bowel disease, clinical remission prior to conception and throughout pregnancy is essential for improved outcomes.
- Laparoscopic cholecystectomy is standard of care regardless of trimester, but should ideally be performed during the second trimester.
- Management of liver diseases related to pregnancy, such as pre-eclampsia, hemolysis, elevated liver enzymes and low platelet syndrome, requires a delivery plan and evaluation for potential liver transplantation.
- Immunosuppressive therapy for chronic liver diseases or following LT should be continued at the lowest possible dose during pregnancy.
“The evaluation and treatment of various GI disorders in pregnancy can be challenging and require a multidisciplinary team to manage these patients during pregnancy and the postpartum period,” Kothari and colleagues wrote. “These conditions include disease states unique to pregnancy and common GI conditions that may be present during pregnancy. A paramount goal is to keep both the patient and the fetus safe.”
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