Melissa Franco, PA: Pregnancy Planning in Patients with Liver Disease

Estimated to affect 3% to 10% of all pregnancies, liver disease in pregnancy poses serious risks to both the mother and the fetus if not promptly detected and treated, or if not adequately planned for in patients with preexisting liver disease.

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

In an interview with HCPLive, Franco described primarily seeing patients with hepatitis B, hepatitis C, autoimmune hepatitis, primary biliary cholangitis, and cirrhosis as an outpatient provider in hepatology, with many of these patients having been diagnosed prior to pregnancy.

“It's very important as a clinician that we know the stage of liver disease prior to conception, and we have to discuss this with the patient,” Franco said. “We have to know for sure once patients get pregnant what their disease is and the stage of fibrosis so we can manage it accordingly based on if they are cirrhotic or noncirrhotic.”

Franco also emphasized the importance of discussing pregnancy intentions prior to conception, ideally having patients on stable doses of immunosuppression and their disease under control before they get pregnant. For patients who do not want to get pregnant, she stressed the need for discussions about birth control, contraceptive methods, and what methods are safe based on the presence or absence of cirrhosis.

“I try to educate patients before they get pregnant,” Franco explained. “We have to inquire from the patients and just know what their intentions are, which is very, very important in making decisions. And of course, if they get pregnant, make sure that they have all the specialists so that we can co-manage the pregnancy if they are high risk.”

Franco called attention the importance of multidisciplinary management in high-risk patients to ensure the safety of both the mother and the child, especially in patients with cirrhosis who are at especially high risk of worsening disease during pregnancy. However, she noted that due to recent advancements in medicine, cirrhosis and portal hypertension are no longer contradictions for pregnancy, despite many clinicians still thinking so and fearing for their safety if a patient with either of these conditions becomes pregnant.

“They will have increased risk of complications, but if they are managed by the right specialist in the right way, they could have a successful pregnancy, they could have successful deliveries, and they could have a healthy baby,” she said.

Reference

^{Wakim-Fleming, J. Liver Diseases in Pregnancy. Cleveland Clinic. Accessed September 16, 2024. https://my.clevelandclinic.org/departments/digestive/medical-professionals/hepatology/liver-disease-in-pregnancy#definition-causes-tab}