5. Hepatotoxic medicines during pregnancy

Twelve hepatotoxic agents were identified as drugs with probability to cause injury in pregnant women are as follows: acetaminophen, alpha-methyldopa, labetalol, methotrexate, saquinavir, nevirapine, propylthiouracil, methimazole, carbimazole, nitrofurantoin, acetylsalicylic acid and piperidolate. Some characteristics associated with these drugs were the time of reaction onset, weeks of pregnancy (between 3 and 36 weeks), risk factors (age and chronic diseases), clinical manifestations (elevation of transaminases, pruritus, vomiting, anorexia and jaundice) and outcomes (liver transplantation and death of mother and/or fetus). In this sense, pregnant women between the second and third decade of age may have an increased risk of liver problems due to the use of medications such as methotrexate, alpha-methyldopa and propylthiouracil. For drugs such as acetaminophen, acetylsalicylic acid, piperidolate, nitrofurantoin, methotrexate and alpha-methyldopa, information about frequency of hepatotoxic reactions during gestation is limited, whereas for antithyroid drugs, the frequency of occurrence of hepatotoxicity can be found between 0.1 and 0.2% of the pregnant population using these drugs [44]. The management in cases of hepatotoxicity in pregnant women must be the suspension of the offending drug, which in most cases afford to improve the symptomatology and prevent fatal outcomes.
