Liver Disease Management During Pregnancy, with Lavinia Iordache, PA

Managing liver disease is often complex in the general population, but it can become even more challenging during pregnancy.

Estimated to affect 3% to 10% of all pregnancies, liver disease during pregnancy is complicated by the need to consider both maternal and fetal health with a multidisciplinary approach to care and thus poses a unique set of challenges.

At the 2024 annual Gastroenterology and Hepatology Advanced Practice Providers (GHAPP) conference in National Harbor, Maryland, Lavinia Iordache, PA, a physician assistant at the University of Miami, conducted a workshop on hepatobiliary disease in pregnancy.

“Liver disease is broad and it stays broad in pregnancy, if not even a little bit more diverse. Obviously, the management would differ from case to case, so I think it is important to individualize patient care,” Iordache explained to HCPLive, citing disease management, prevention of maternal symptoms, improving the patient’s quality of life, and preventing fetal complications as some of the main considerations for care in this patient population.

She also emphasized the importance of being mindful of potential toxicities and risks to the mother and the fetus during hepatic care. However, she noted many medications used to treat liver disease are safe for use during pregnancy, including prednisone and ursodeoxycholic acid.

“I think it's important for patients to have a good understanding of what the plan should be in any particular case and to feel confident and understand why we're doing certain things, the risks, the benefits, and that will make them feel like they can make an empowered decision,” Iordache added.

Beyond educating patients, Iordache also stressed the importance of providers utilizing a multispecialty approach with hepatologists, gastroenterologists, obstetrics gynecologists, and primary care physicians to manage liver disease in pregnancy and ensure the “best possible outcome” for patients.

Check out this interview with Iordache about the presentation and diagnosis of hepatobiliary issues in pregnancy!

Reference

^{Wakim-Fleming, J. Liver Diseases in Pregnancy. Cleveland Clinic. Accessed September 17, 2024. https://my.clevelandclinic.org/departments/digestive/medical-professionals/hepatology/liver-disease-in-pregnancy#definition-causes-tab}