Wilson disease (WD) can increase the risk of miscarriage, premature birth, and perinatal mortality, but careful monitoring and management by medical professionals can improve quality of life and the chances of a successful pregnancy, according to a case series published in Medicine.
In the case series, 3 of the 4 pregnancies in women with WD resulted in healthy, although often premature, babies following careful clinical management of their condition. The remaining patient experienced premature spontaneous abortion at 25 weeks of gestation.
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“In our case, the 1st, 3rd, and 4th pregnant women had successful pregnancy after treatment, and the outcome was satisfactory. These examples suggest that WD pregnant women have the hope of being a mother, may have better pregnancy outcomes after standardized treatment and guidance in professional hospitals,” the authors wrote.
The series showed that treatment with a copper-chelating agent, such as D-penicillamine, combined with a low-copper diet could reduce the level of disease and help to achieve better pregnancy outcomes. The mother in case 1 began treatment with penicillamine at 12 weeks of gestation in combination with a low-copper diet after stopping treatment half a year before pregnancy. She was able to delivery a healthy baby via cesarean section at 32 weeks.
The mother in case 4 had good compliance with penicillamine treatment and was able to vaginally deliver a healthy baby at 36 weeks. The patient had previously experienced 3 missed abortions prior to her diagnosis with WD and initiation of treatment.
The mother in case 3 stopped taking penicillamine after becoming pregnant and was able to deliver a healthy child at 33 weeks of gestation. Ultrasonographic examination showed cirrhosis, however, so the patient began treatment with penicillamine after delivery.
The mother in case 2 found out that she was pregnant 1 month after stopping treatment. She refused the suggested treatments and was found to have decompensated cirrhosis with coagulation dysfunction at 22 weeks of pregnancy. At 25 weeks, she presented to the hospital with contractions, anemia, edema, and old ecchymoses on her skin. She later delivered a dead baby 2 days after admission.
Xiong X, Wei H, Zhu Y, et al. Wilson disease in pregnancy: a case series. Medicine (Baltimore). Published online February 17, 2023. doi:10.1097/MD.0000000000032968