GI and Liver disease in pregnancy

Question 1

Is endoscopy safe during pregnancy?

Answer 1

Yes! Especially during the second trimester

Question 2

What should be avoided for constipation in pregnancy?

Answer 2

Mineral oil and castor oil should be avoided because they are teratogenic

Question 3

Fertility in IBD?

Answer 3

Same as general population if disease is quiescent. Patients with IPAA have decreased fertility

Question 4

How to improve fertility and pregnancy outcomes in IBD?

Answer 4

Remission for 3-6 months prior to conception

Question 5

Fertility in celiac disease?

Answer 5

Decreased. Also increase risk of birth defects

Question 6

What do the G1528C and E474Q mutations of mitochondrial trifunctional protein cause?

Answer 6

Deficiency in long chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) which is the most investigated fetal fatty acid oxidation defect implicated in acute fatty liver of pregnancy

Question 7

How to diagnose intrahepatic cholestasis of pregnancy?

Answer 7

Look at serum bile acid levels (>10).

Question 8

What is the level of bile acids that will cause complication in intrahepatic cholestasis of pregnancy

Answer 8

> 40

Question 9

How to treat ICP?

Answer 9

Ursodiol and early delivery of fetus at 37 weeks in order to decrease the risk of intrauterine death.

Question 10

What to do if there is suspicion for HSV hepatitis

Answer 10

Treat with IV acyclovir right away, even before diagnosis is made. Facial or genital lesions can be absent

Question 11

How to prevent maternal transmission of hepatitis B

Answer 11

HBIG and vaccination within 12 hours of birth, then regularly scheduled hepatitis B vaccination

Question 12

Risk factors for AIH flares in pregnancy

Answer 12

Flare in the last year and those who are not on therapy

Question 13

How long to wait after liver transplant to conceive?

Answer 13

1 year. Fertility restored in 80-90% of women.