Women with alcoholic liver disease (ALD) who are pregnant often have higher age, body mass index, smoke cigarettes during pregnancy, and have lower socioeconomic status. Their infants are at increased risk of preterm birth, low Apgar scores, and being small-for-gestational-age. Similar but slightly lower risks are seen for women diagnosed with ALD after giving birth. Treatment for ALD in pregnancy includes managing complications like ascites, hepatic encephalopathy, and portal hypertension. The presentation discusses effects of alcohol on the fetus, liver, and pregnancy outcomes.

2. Alcoholic Liver Disease in
Pregnancy
Dr Nasir Khokhar MD FACP FACG
Prof of Medicine and Gastroenterology
Shifa International
Islamabad

7. Alcohol effect on fetus brain

8. Effects on Fetus

9. Alcohol effects

10. Women with ALD were generally of higher age and body mass
index, more likely to smoke cigarettes during pregnancy and to
have a low socio-economic status.
They had an increased risk of very preterm birth. Infants of were
at increased risk for low Apgar scores (<7) at 5 min.
Similar associations with slightly lower-risk estimates were found
among women diagnosed with ALD after birth.
Mothers with Alcoholic Liver Disease and the Risk for Preterm and Small-for-
gestational-age Birth. Alcohol and Alcoholism 2013;48:166–171.
Pregnancy, Alcohol and fetus

15. Alcohol and liver

19. Clinical Presentations

22. Fatty liver Normal liver

23. Alcohol and HCV

24. Liver problems in pregnancy

25. Liver disease in pregnancy

26. Clinical Manifestations

30. Pathogenesis

31. Role of mitochondria

33. Mitochondrial Dysfunction

34. Role of mitochondria

35. Alcohol induced liver disease

36. Alcohol induced liver disease

37. Effects of acetaldehyde

38. Immunologic aspects

39. Treatment

42. Treatment of Fatty liver

43. Illness severity and risk of poor
outcome in alcoholic hepatitis
• Maddrey discriminant function (MDF): based
on PT and bilirubin: greater than 32 indicate
severe disease; 30-day mortality
approximately 50%
• Combined Clinical and Laboratory Index
• Model for end-stage liver disease (MELD)
score
• Glasgow alcoholic hepatitis score (GAHS)
• Asymmetric dimethylarginine (ADMA) score

44. Treatment of Acute Alcoholic Hepatitis
With Prednisolone ± N-Acetyl Cysteine
Nguyen-Khac E, et al. AASLD 2009. Abstract 91.
Prednisolone 40 mg/day for 28 days +
NAC IV on Days 1-5*
(n = 85)
Prednisolone 40 mg/day for 28 days +
5% Glucose (Carrier) IV on Days 1-5
(n = 89)
Pts with
acute alcoholic
hepatitis
(N = 174)
Follow-up:
Mos 1, 2, 3, 6
Stratified by center
*Day 1 NAC: 150 mg/kg in 250 mL 5% glucose over 15 mins; 50 mg/kg in 500 mL 5% glucose over 4 hrs;
100 mg/kg in 1000 mL 5% glucose over 16 hrs. Days 2-5 NAC: 100 mg/kg in 1000 mL 5% glucose.
Mortality, % Prednisolone + NAC
(n = 85)
Prednisolone + Carrier
(n = 89)
P Value
Mo 6 (primary endpoint) 27.1 38.2 .117
Mo 1 8.2 23.6 .005
Mo 2 15.3 32.6 .007
Mo 3 22.4 33.7 .095
N Engl J Med 2011;365:1781-9.

45. Management of alcoholic hepatitis

46. Management of cirrhosis and its
complications
• Portal Hypertension: Variceal
bleeding, Ascites, Hepato renal
syndrome, Spontaneous Bacterial Peritonitis
• Hepato cellular failure: Hepatic
encephalopathy
• Hepato cellular carcinoma

50. In pregnancy, Not this drink

51. But this drink

52. Thanks