DILI in Pregnancy-DILI In Pregnancy

Video Transcription

Video Summary

Dr. Tatyana Kushner presented a talk on drug-induced liver injury (DILI) in pregnancy and the perinatal period, highlighting major knowledge gaps and the importance of considering DILI in pregnant patients with unexplained liver test abnormalities. She opened with a striking case of gestational alloimmune liver disease (GALD) treated with IVIG, where the patient developed severe hepatitis consistent with DILI and improved after prednisone. The case recurred in a later pregnancy, again suggesting IVIG-associated liver injury.<br /><br />She reviewed how medication and herbal use remain common in pregnancy, making DILI more relevant than often assumed. Current AASLD and EASL guidance recommends careful history-taking, including prescription, over-the-counter, herbal, and vitamin products. Available data suggest DILI in pregnancy is uncommon but real, and may be underrecognized.<br /><br />Dr. Kushner described that DILI in pregnancy can be severe, heterogeneous, and sometimes show autoimmune features or cholestatic patterns. Reported culprits include methyldopa, labetalol, isoniazid, rifampin, thiopurines, antibiotics, and others. She also emphasized the postpartum period, where immune rebound may increase risk of liver injury. Liver biopsy can be useful when diagnosis is unclear and is generally safe when medically indicated. The talk concluded with a call for more data on maternal and neonatal outcomes and better pregnancy-specific DILI registries.

Keywords

drug-induced liver injury

DILI in pregnancy

pregnancy liver abnormalities

gestational alloimmune liver disease

IVIG-associated hepatitis

maternal medication exposure

postpartum liver injury

cholestatic hepatitis

pregnancy-specific DILI registries