Drug-Induced Liver Injury after IVF: comorbidity, forced polypharmacy

Abstract

The growth of liver tests in the second half of pregnancy is most often caused by two reasons - Intrahepatic Cholestasis of pregnancy (ICP) and rarely diagnosed Drug-Induced Liver Injuries (DILI). In Assisted Reproductive Technology (ART)-induced pregnancies that are accompanied by powerful drug support, the incidence of drug-induced cholestasis increases. This is due to the combined use of gestagens and other drugs that have hepatotoxic potential for the prevention of miscarriage. The article reveals the risks of IVF, which is often performed for women in late reproductive age, accompanied by multiple pregnancies, somatic pathology, thrombophilia and forced polypharmacy. The article presents an analysis of the clinical observation of a pregnant woman as a result of IVF, who developed acute drug hepatitis against the background of polypharmacy, and its examination according to the criteria of the European Association for the Study of the Liver (EASL) and the RUCAM algorithm. The author believes that the limitation of the RUCAM scale is manifested by insufficient consideration of the effect of pregnancy and polypharmacy on the development of DILI. According to the author, it is necessary to differentiate the DILI from ICP in connection with the peculiarities in the management tactics, despite their probable genetic affinity and clinical and laboratory similarities. The author suggests that DILI during pregnancy is a reservoir for the subsequent development of chronic diffuse liver diseases in women. In this regard, such patients need the observation of a therapist for 6-12 months after childbirth.