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Shakerdi LA, McNulty J, Gillman B, McCarthy CM, Ivory J, Sheerin A, O'Byrne JJ, Donnelly JC, Treacy EP. Management of pregnancy in a patient with long‐chain 3‐hydroxyacyl
CoA
dehydrogenase deficiency. JIMD Rep 2022; 63:265-270. [PMID: 35822088 PMCID: PMC9259390 DOI: 10.1002/jmd2.12284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 11/16/2022] Open
Abstract
Long‐chain 3‐hydroxyacyl‐CoA dehydrogenase deficiency (LCHADD) is a rare mitochondrial defect of β‐oxidation of long‐chain fatty acids. Patients may present with muscle pain, hypotonia, peripheral neuropathy, cardiomyopathy, recurrent rhabdomyolysis and sudden death. Dietary management of LCHADD aims at preventing prolonged fasting and decreasing energy production from long‐chain fatty acids compensated by an increase in medium‐chain triglyceride fat. Herein, we present medical and dietetic management of a successful pregnancy in a LCHADD female patient and the delivery of a healthy baby boy.
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Affiliation(s)
- Loai A. Shakerdi
- National Centre for Inherited Metabolic Disorders Mater Misericordiae University Hospital Dublin Ireland
| | - Jenny McNulty
- National Centre for Inherited Metabolic Disorders Children's Health Ireland (CHI) Dublin Ireland
| | - Barbara Gillman
- National Centre for Inherited Metabolic Disorders Mater Misericordiae University Hospital Dublin Ireland
| | | | - Jessica Ivory
- National Centre for Inherited Metabolic Disorders Mater Misericordiae University Hospital Dublin Ireland
| | - Alison Sheerin
- National Centre for Inherited Metabolic Disorders Mater Misericordiae University Hospital Dublin Ireland
| | - James J. O'Byrne
- National Centre for Inherited Metabolic Disorders Mater Misericordiae University Hospital Dublin Ireland
| | | | - Eileen P. Treacy
- National Centre for Inherited Metabolic Disorders Mater Misericordiae University Hospital Dublin Ireland
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Wang HY, Jiang Q, Shi H, Xu YQ, Shi AC, Sun YL, Li J, Ning Q, Shen GX. Effect of caesarean section on maternal and foetal outcomes in acute fatty liver of pregnancy: a systematic review and meta-analysis. Sci Rep 2016; 6:28826. [PMID: 27387594 PMCID: PMC4937371 DOI: 10.1038/srep28826] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 06/02/2016] [Indexed: 12/20/2022] Open
Abstract
Several studies have reported a positive association between caesarean section for expeditious pregnancy termination and perinatal outcomes in acute fatty liver of pregnancy (AFLP); however, the risks remain unclear and independent studies have reported conflicting findings. In this meta-analysis, we aimed to confirm the relationship between caesarean section and perinatal outcomes in AFLP. The PubMed, Embase, and China National Knowledge Infrastructure databases were searched (until July 17, 2015) for observational clinical studies focusing on the association between caesarean section and perinatal outcomes in AFLP. Data were extracted and processed independently by 2 authors. We also compared caesarean section with vaginal delivery to further investigate this relationship. We observed that 2 of the 3 primary outcomes in caesarean section exhibited positive effects-the maternal mortality rate was 44% lower (relative risk [RR], 0.56 [0.41-0.76]) and perinatal mortality rate was also reduced (RR, 0.52 [0.38-0.71]), compared to those for vaginal delivery. We did not find any associations between caesarean section and perinatal outcomes in AFLP in terms of neonatal mortality type and maternal multiple organ complications. These findings emphasise the significant prognostic value and clinical implications of caesarean section in AFLP, and suggest that the adverse outcomes should be reduced.
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Affiliation(s)
- Hong-Yan Wang
- Department of Infectious Disease, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Gastroenterology, Shenzhen Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Shenzhen, China
| | - Qing Jiang
- Department of Immunology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Allergy, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Shi
- Department of Epidemiology and Biostatistics, and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yun-Qing Xu
- Department of Immunology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ai-Chao Shi
- Department of Infectious Disease, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuan-Li Sun
- Department of Immunology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian Li
- Department of Gastroenterology, Shenzhen Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Shenzhen, China
| | - Qin Ning
- Department of Infectious Disease, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guan-Xin Shen
- Department of Immunology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Ding J, Han LP, Lou XP, Geng LN, Liu D, Yang Q, Gao S. Effectiveness of Combining Plasma Exchange with Plasma Perfusion in Acute Fatty Liver of Pregnancy: A Retrospective Analysis. Gynecol Obstet Invest 2015; 79:97-100. [DOI: 10.1159/000368752] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 09/29/2014] [Indexed: 11/19/2022]
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Kobayashi T, Minami S, Mitani A, Tanizaki Y, Booka M, Okutani T, Yamaguchi S, Ino K. Acute fatty liver of pregnancy associated with fetal mitochondrial trifunctional protein deficiency. J Obstet Gynaecol Res 2014; 41:799-802. [PMID: 25420603 DOI: 10.1111/jog.12609] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 09/03/2014] [Indexed: 12/17/2022]
Abstract
Acute fatty liver of pregnancy (AFLP) is a devastating disorder of the maternal liver in the third trimester. Recent studies have demonstrated an association between AFLP and fetal fatty acid oxidation disorders. Here, we report a case of AFLP caused by fetal mitochondrial trifunctional protein (TFP) deficiency. A 21-year-old parous woman presented with nausea, genital bleeding and abdominal pain at 33 weeks of gestation. Laboratory data revealed hepatic failure and disseminated intravascular coagulopathy. The patient underwent emergency cesarean section and was diagnosed with AFLP from the clinical characteristics. She was successfully treated with frequent plasma exchange. The newborn presented severe heart failure and died on the 39th day after birth. Tandem mass spectrometry indicated long-chain fatty acid oxidation disorder. Gene analysis demonstrated homozygous mutation in exon 13 of HADHB, the gene responsible for mitochondrial TFP deficiency. The parents carried a heterozygous mutation at the same location in HADHB.
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Affiliation(s)
- Tomoko Kobayashi
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama, Japan
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de Oliveira CV, Moreira A, Baima JP, Franzoni LDC, Lima TB, Yamashiro FDS, Coelho KYR, Sassaki LY, Caramori CA, Romeiro FG, Silva GF. Acute fatty liver of pregnancy associated with severe acute pancreatitis: A case report. World J Hepatol 2014; 6:527-531. [PMID: 25068005 PMCID: PMC4110545 DOI: 10.4254/wjh.v6.i7.527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/20/2014] [Accepted: 06/11/2014] [Indexed: 02/06/2023] Open
Abstract
Acute fatty liver of pregnancy is a rare disease that affects women in the third trimester of pregnancy. Although infrequent, the disease can cause maternal mortality. The diagnosis is not always clear until the pregnancy is terminated, and significant complications, such as acute pancreatitis, can occur. Pancreatic involvement typically only occurs in severe cases after the development of hepatic and renal impairment. To date, little knowledge is available regarding how the disease causes pancreatitis. Treatment involves supportive measures and pregnancy interruption. In this report, we describe a case of a previously healthy 26-year-old woman at a gestational age of 27 wk and 6 d who was admitted with severe abdominal pain and vomiting. This case illustrates the clinical and laboratory overlap between acute fatty liver of pregnancy and pancreatitis, highlighting the difficulties in differentiating each disease. Furthermore, the hypothesis for this overlapping is presented, and the therapeutic options are discussed.
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