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Pregnancy in PSC and after liver transplantation

Authors: Mussarat N Rahim and Professor Michael A Heneghan

Dr Rahim and Professor Heneghan from King's College Hospital London have written this comprehensive information about pregnancy in PSC. It includes everything you need to know if you have PSC or are post-transplant and thinking of starting a family.

The most important thing to take away from this information is that with support from your medical team, it is possible to have a successful pregnancy with PSC and after liver transplantation.

Medications during pregnancy and breastfeeding

Ursodeoxycholic acid

UDCA can be continued and may require escalation during pregnancy in people with PSC 7.

Immunosuppressants

Most immunosuppressive medications can be continued during pregnancy, except for mycophenolate mofetil which should be changed to a suitable alternative at least 12 weeks prior to conception 6.

As with most medications, there is little data on the safety of drugs used in PSC and post-transplant in human pregnancies.  However, based on expertise and general practice, please refer to the table below for more information on specific medications during pregnancy. If there are any concerns, this needs to be discussed with your hepatologist/obstetrician. We would not recommend that you stop any drugs without informing your medical team as a flare of your liver disease could have harmful consequences on you and your pregnancy. Weighing up the risks versus benefits of continuing a drug during pregnancy should also be discussed with your medical team.

Drug Advice during pregnancy Breastfeeding
Propranolol In practice, if already on this drug, it can continue during pregnancy Unlikely to cause harm
Carvedilol In practice, if already on this drug, it can continue during pregnancy Can continue if benefits outweigh potential risks
Spironolactone Ideally discontinue during pregnancy Can continue if benefits outweigh potential risks
Frusemide Ideally discontinue during pregnancy Can continue if benefits outweigh potential risks
Rifaximin Not enough evidence, ideally discontinue during pregnancy Can continue if benefits outweigh potential risks
Lactulose In practice, widely used without adverse effects Can continue if benefits outweigh potential risks
Prednisolone In practice, if already on this drug, it can continue during pregnancy (at lowest dose possible) Can continue (at lowest doses possible) if benefits outweigh potential risks
Azathioprine In practice, if already on this drug, it can continue during pregnancy Can continue if benefits outweigh potential risks (baby may require extra monitoring)
Mercaptopurine In practice, if already on this drug, it can continue during pregnancy Can continue if benefits outweigh potential risks (baby may require extra monitoring)
Mycophenolate mofetil Likely to cause harm so must be stopped 12 weeks prior to conception Avoid if possible
Cyclosporine In practice, if already on this drug, it can continue during pregnancy Avoid is possible
Tacrolimus In practice, if already on this drug, it can continue during pregnancy Can continue if benefits outweigh potential risks (baby may require extra monitoring)
UDCA (ursodeoxycholic acid) In practice, widely used without adverse effects Can continue if benefits outweigh potential risks
Cholestyramine In practice, widely used without adverse effects Can continue if benefits outweigh potential risks
Naltrexone In practice, unlikely to cause harm but avoid if possible Can continue if benefits outweigh potential risks
Rifampicin In practice, unlikely to cause harm Compatible with breastfeeding

 

Date reviewed: 9 January 2021

References

1 Janczewska I, Olsson R, Hultcrantz R, Broome U. Pregnancy in patients with primary sclerosing cholangitis. Liver. 1996 Oct;16(5):326-30

2 Cauldwell M, Mackie FL, Steer PJ, Henehghan MA, Baalman JH, Brennand J, Johnston T, Dockree S, Hedley C, Jarvis S, Khan S. Pregnancy outcomes in women with primary biliary cholangitis and primary sclerosing cholangitis: a retrospective cohort study. BJOG: An International Journal of Obstetrics & Gynaecology. 2020 Jun;127(7):876-84

3 Ludvigsson JF, Bergquist A, Ajne G, Kane S, Ekbom A, Stephansson O. A population-based cohort study of pregnancy outcomes among women with primary sclerosing cholangitis. Clinical Gastroenterology and Hepatology. 2014 Jan 1;12(1):95-100

4 Wellge BE, Sterneck M, Teufel A, Rust C, Franke A, Schreiber S, Berg T, Günther R, Kreisel W, Zu Eulenburg C, Braun F. Pregnancy in primary sclerosing cholangitis. Gut. 2011 Aug 1;60(8):1117-21

5 Gonsalkorala ES, Cannon MD, Lim TY, Penna L, Willliamson C, Heneghan MA. Non-invasive markers (ALBI and APRI) predict pregnancy outcomes in women with chronic liver disease. American Journal of Gastroenterology. 2019 Feb 1;114(2):267-75

6 Rahim MN, Long L, Penna L, Williamson C, Kametas NA, Nicolaides KH, Heneghan MA. Pregnancy in liver transplantation. Liver Transplantation. 2020 Apr;26(4):564-81

7 de Vries E, Beuers U. Ursodeoxycholic acid in pregnancy?. Journal of hepatology. 2019 Dec 1;71(6):1237-45

https://www.gov.uk/drug-safety-update/mycophenolate-mofetil-mycophenolic-acid-updated-contraception-advice-for-male-patients (accessed 15 February 2021)

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