Study on the etiology, clinical manifestations, and pregnancy outcomes of drug-induced liver injury in pregnancy

Abstract

Abstract: Objective To explore the etiology, clinical manifestations, and pregnancy outcomes of drug-induced liver injury (DILI) during pregnancy. Methods A total of 98 pregnant female patients diagnosed with drug-induced liver injury hospitalized at our institution from January 2020 to October 2024 were included in the observation group. Meanwhile, 102 pregnant female patients with normal liver function during pregnancy, who underwent examination at our hospital during the same period were chosen as the control group. Clinical data were collected from both groups to analyze the etiology of DILI in the observation group and to compare liver function indicators and pregnancy outcomes between the two groups. Results The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), total bile acid (TBA), and albumin (Alb) in the observation group were (152.11±20.47) U/L, (138.48±14.58) U/L, (30.45±4.26) μmol/L, (20.68±3.17) μmol/L, respectively, higher than those in the control group, while ALB was lower than the control group [(30.15±4.18) vs (39.41±4.56) g/L], with statistical significance (P<0.05). Among the 98 patients in the observation group, 36 cases (36.73%) had concomitant viral hepatitis, including 6 cases of hepatitis A, 20 cases of hepatitis B, 4 cases of hepatitis C, 3 cases of cytomegalovirus infection, and 3 cases of Epstein-Barr virus infection. Additionally, 16 cases (16.33%) had gestational hypertension; 24 cases (24.49%) had intrahepatic cholestasis of pregnancy; 12 cases (12.24%) had hyperthyroidism and were treated with propylthiouracil; 19 cases (19.39%) had depression and were treated with sertraline; 18 cases (18.37%) self-administered herbal medicines or related health supplements; and 10 cases (10.20%) used antibiotics. The proportions of patients with viral hepatitis, gestational hypertension, intrahepatic cholestasis of pregnancy, hyperthyroidism, depression, use of herbal medicines, use of antibiotics, and adverse pregnancy outcomes were higher in the observation group than that in the control group (P<0.05). Conclusion Drug-induced liver injury during pregnancy is strongly linked to various causes, resulting in liver dysfunction and a higher risk of adverse pregnancy outcomes.

Key words: Pregnancy, Drug-induced liver injury, Pregnancy outcomes, Risk factor analysis

WANG Feng-mei, YANG Yue, HE Ya-jie. Study on the etiology, clinical manifestations, and pregnancy outcomes of drug-induced liver injury in pregnancy[J]. Chinese Hepatolgy, 2025, 30(6): 852-856.

References

[1] Pathak J, Goel N, Jha S K, et al. Comparing feto-maternal outcomes in pregnant women with normal and abnormal liver function tests: a prospective observational study[J]. Cureus, 2024, 16(3):e56811.
[2] Masood U, Venturini N, Nicoletti P, et al. Drug-induced liver injury in pregnancy: the U.S. drug-induced liver injury network experience[J]. Obstet Gynecol, 2024, 143(6):819-823.
[3] 王双双, 熊清芳, 胡一帆, 等. 药物性肝损伤的临床与病理特点分析[J]. 肝脏,2023,28(11):1280-1284.
[4] Lao TT. Drug-induced liver injury in pregnancy[J]. Best Pract Res Clin Obstet Gynaecol, 2020, 68:32-43.
[5] 母光頔, 李佳怡, 高云娟, 等. 妊娠女性药物相关肝损伤风险的识别及分析[J]. 临床肝胆病杂志,2022,38(8):1834-1838.
[6] 中华医学会肝病学分会药物性肝病学组. 药物性肝损伤诊治指南. 中华肝脏病杂志, 2015, 23(11):810-820.
[7] 中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2022年版)[J]. 实用肝脏病杂志,2023,26(3):后插1-后插22.
[8] 陈鹏, 刘兴会, 吴琳. 妊娠期肝内胆汁淤积症指南解读[J]. 实用妇产科杂志,2019,35(2):103-105.
[9] 乔东艳, 孙白云, 虞天一, 等. 早发型子痫前期患者血清细胞焦亡相关因子的表达及临床分析[J].东南大学学报(医学版),2019,38(01):145-149.
[10] 《妊娠和产后甲状腺疾病诊治指南》(第2版)编撰委员会, 中华医学会内分泌学分会, 中华医学会围产医学分会. 妊娠和产后甲状腺疾病诊治指南(第2版)[J]. 中华内分泌代谢杂志,2019,35(8):636-665.
[11] 魏倩, 李蕾, 曾晓清, 等. 药物性肝损伤患者的临床特征及预后相关危险因素分析[J]. 中华肝脏病杂志,2024,32(3):214-221.
[12] Marrone G, Galati F, Biolato M, et al. Acute liver failure in still′s disease relapse during pregnancy: case report and discussion of a possible trigger role of DILI[J]. BMC Gastroenterol, 2021, 21(1):317.
[13] Aubrecht J, Potter D, Sauer J M, et al. Serum glutamate dehydrogenase activity enables sensitive and specific diagnosis of hepatocellular injury in humans[J]. Toxicol Sci, 2024: kfae143.
[14] Ho S Y, Liu P H, Hsu C Y, et al. Albumin-based liver reserve models vs. MELD 3.0 in prognostic prediction for hepatocellular carcinoma patients with renal insufficiency[J]. Int J Mol Sci, 2023, 24(23):16987.
[15] Solis Paredes J M, Perichart Perera O, Montoya Estrada A, et al. Gestational weight gain influences the adipokine-oxidative stress association during pregnancy[J]. Obes Facts, 2021, 14(6):604-612.
[16] 支艳俊. 100例妊娠期肝功能异常患者的临床分析[J]. 临床与病理杂志,2022,42(4):841-846.
[17] Gong C, Bertagnolli L N, Boulton D W, et al. A literature review of changes in phase Ⅱ drug-metabolizing enzyme and drug transporter expression during pregnancy[J]. Pharmaceutics, 2023, 15(11):2624.
[18] 马丽君, 翟独秀, 李祥雯. 甲基多巴或硝苯地平治疗妊娠高血压综合征的效果及对妊娠结局的影响[J]. 中国医药,2023,18(10):1532-1536.
[19] Khatri R, Fallon J K, Sykes C, et al. Comparison of the safety between propylthiouracil and methimazole with hyperthyroidism in pregnancy: a systematic review and meta-analysis[J]. PLoS One, 2023, 18(5):e0286097.
[21] Stika C S, Wisner K L, George A L Jr, et al. Changes in sertraline plasma concentrations across pregnancy and postpartum[J]. Clin Pharmacol Ther, 2022, 112(6):1280-1290.
[22] Chen S, Wu Q, Li X, et al. The role of hepatic cytochrome P450s in the cytotoxicity of sertraline[J]. Arch Toxicol, 2020, 94(7):2401-2411.
[23] 吕东霞, 张帆, 秦佳琪, 等. 中草药相关肝损伤诊断的现状与进展[J]. 中草药,2024,55(5):1761-1769.
[24] Ghassa A, Ismail M, Alani L A A. Teucrium polium: new toxic effects added to the literature: a case report[J]. Ann Med Surg (Lond), 2024, 86(5):3005-3008.