Alcoholic Liver Disease in Pregnancy

Dr Nasir Khokhar MD FACP FACGProf of Medicine and Gastroenterology

Shifa International Islamabad

Alcohol effect on fetus brain

Effects on Fetus

Alcohol effects

Women with ALD were generally of higher age and body mass index, more

likely to smoke cigarettes during pregnancy and to have a low socio-

economic status.

They had an increased risk of very preterm birth. Infants of were at increased

risk for low Apgar scores (<7) at 5 min.

Similar associations with slightly lower-risk estimates were found among

women diagnosed with ALD after birth.

Mothers with Alcoholic Liver Disease and the Risk for Preterm and Small-for-gestational-age Birth. Alcohol and Alcoholism 2013;48:166–171.

Pregnancy, Alcohol and fetus

Alcohol and liver

Clinical Presentations

Fatty liver Normal liver

Alcohol and HCV

Liver problems in pregnancy

Liver disease in pregnancy

Clinical Manifestations

Pathogenesis

Role of mitochondria

Mitochondrial Dysfunction

Role of mitochondria

Alcohol induced liver disease

Alcohol induced liver disease

Effects of acetaldehyde

Immunologic aspects

Treatment

Treatment of Fatty liver

Illness severity and risk of poor outcome in alcoholic hepatitis

• Maddrey discriminant function (MDF): based on PT and bilirubin: greater than 32 indicate severe disease; 30-day mortality approximately 50%

• Combined Clinical and Laboratory Index • Model for end-stage liver disease (MELD) score • Glasgow alcoholic hepatitis score (GAHS)• Asymmetric dimethylarginine (ADMA) score

Treatment of Acute Alcoholic Hepatitis With Prednisolone ± N-Acetyl Cysteine

Nguyen-Khac E, et al. AASLD 2009. Abstract 91.

Prednisolone 40 mg/day for 28 days + NAC IV on Days 1-5*

(n = 85)

Prednisolone 40 mg/day for 28 days + 5% Glucose (Carrier) IV on Days 1-5

(n = 89)

Pts with acute alcoholic

hepatitis

(N = 174)

Follow-up: Mos 1, 2, 3, 6

Stratified by center

*Day 1 NAC: 150 mg/kg in 250 mL 5% glucose over 15 mins; 50 mg/kg in 500 mL 5% glucose over 4 hrs; 100 mg/kg in 1000 mL 5% glucose over 16 hrs. Days 2-5 NAC: 100 mg/kg in 1000 mL 5% glucose.

Mortality, % Prednisolone + NAC(n = 85)

Prednisolone + Carrier (n = 89)

P Value

Mo 6 (primary endpoint) 27.1 38.2 .117

Mo 1 8.2 23.6 .005

Mo 2 15.3 32.6 .007

Mo 3 22.4 33.7 .095

N Engl J Med 2011;365:1781-9.

Management of alcoholic hepatitis

Management of cirrhosis and its complications

• Portal Hypertension: Variceal bleeding, Ascites, Hepato renal syndrome, Spontaneous Bacterial Peritonitis

• Hepato cellular failure: Hepatic encephalopathy

• Hepato cellular carcinoma

In pregnancy, Not this drink

But this drink

Thanks