Факторы риска лекарственного поражения печени в I триместре беременности

Abstract

Study Objective: to identify the risk factors of drug-induced liver involvement in first trimester of pregnancy. Study Design: prospective randomized comparative clinical research. Materials and Methods. At the Scientific Centre of Obstetrics, Gynaecology and Reproductive Medicine named after D.O. Ott, we selected 113 pregnant women in first trimester of pregnancy. The study group included 81 patients with clinical, anamnestic and biochemical signs of drug-induced liver involvement, while the comparison group included 20 pregnant women who took hormonal drugs to prevent or treat habitual miscarriage and who did not have aminotransferases changed; and the control group of 12 healthy women who did not take any hormonal drugs. Diagnosis of hepatic involvement was based on the RUCAM criteria (Roussel Uclaf Causality Assessment Method). We assessed biochemical blood analysis which demonstrated hepatic functional status; ultrasound results for liver and gall bladder; amount and types of drugs used; incidence of background gynaecological and somatic disorders. Study Results: During pregnancy planning, 71.8% of women from the study group were treated with hormonal agents; 49.4% had their present pregnancy after in vitro fertilisation (IVF) and cryoconservation protocol. In addition to hormonal therapy, in first trimester of pregnancy some patients were prescribed antimicrobials and immunoglobulins, more frequently in the study group (31.3% and 34.3%, respectively). Apart from hormonal agents, women in the study group were prescribed 7.7 ± 0.2 medicines on the average vs. 3.8 ± 0.3 medicines in controls. Pregnant women in the study group were treated with hormones for 35 ± 1.7 days vs. 15.8 ± 0.8 days in controls. Conclusion. The following risk factors of drug-induced hepatic involvement in first trimester of pregnancy were identified: hormonal therapy during pregnancy planning and in first trimester of pregnancy; pregnancy after ovulation stimulation and IVF; long-term use (over 4 weeks) of estrogenic and gestagenic drugs; polypragmasy. No correlation was found between somatic disorders and the risk of hepatic involvement. Hepatocellular hepatic involvement prevailed; the incidence of cholestatic and vessel types made 9% and 5%, respectively. Keywords: drug-induced liver involvement, pregnancy, first trimester, oestrogens, gestagens, risk factors.