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Drug-Induced Liver Injury in Pregnancy: The U.S. Drug-Induced Liver Injury Network Experience
Umair Masood1, Nicholas Venturini, Paola Nicoletti
1Division of Liver Diseases and the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York; Duke University School of Medicine and the Duke Clinical Research Institute, Durham, and Wake Forest University School of Medicine and Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina; National Institutes of Health, Bethesda, Maryland; Indiana University School of Medicine, Indianapolis, Indiana; and Albert Einstein Medical Center, Philadelphia, Pennsylvania.
Drug-induced liver injury (DILI) during pregnancy is rare but more severe than in nonpregnant individuals. Key recommendations include deferring isoniazid and using alternative hypertension medications during pregnancy.
Area of Science:
- Hepatology
- Obstetrics & Gynecology
- Clinical Pharmacology
Background:
- Limited data exist on drug-induced liver injury (DILI) causes and characteristics in pregnant individuals.
- Pregnancy-related DILI presents unique challenges for patient management and safety.
Purpose of the Study:
- To characterize DILI in pregnant individuals.
- To compare DILI severity and outcomes between pregnant and nonpregnant women of childbearing age.
Main Methods:
- Retrospective review of DILI cases from the multicenter Drug-Induced Liver Injury Network (2004-2022).
- Inclusion criteria: DILI during pregnancy or within 6 months postpartum.
- Comparison group: DILI cases in nonpregnant women of childbearing age.
Main Results:
- 16 of 325 (5%) DILI cases occurred during pregnancy or postpartum.
- Pregnancy-related DILI was significantly more severe than in nonpregnant women (P <.05).
- Documented outcomes included one elective termination and three miscarriages; no maternal deaths.
Conclusions:
- Isoniazid for latent tuberculosis should be deferred to the postpartum period when possible.
- For hypertension management during pregnancy, beta-blockers or calcium channel blockers are preferred over methyldopa.
- Further research is needed to understand DILI pathophysiology and optimize management in pregnancy.
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