Problems during and after pregnancy in female patients with biliary atresia Hideyuki Sasaki a,b, * , Masaki Nio c , Yutaka Hayashi a , Tomohiro Ishii a , Nobuyuki Sano c , Ryoji Ohi c a Department of Pediatric Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan b Department of Pediatric Surgery, Iwaki Kyoritsu General Hospital, 973-8555, Japan c Department of Surgery, Miyagi Children Hospital, 989-3126, Japan Abstract Background/Purpose: Advances in the management for biliary atresia (BA) have improved the prognosis and has greatly increased the number of long-term survivors. Even the long-term survivors, however, still face some problems. This retrospective review was performed to assess pregnancy- associated issues in long-term survivors after surgery for BA. Materials and Methods: Of 55 patients with BA surviving for 16 years or more without liver transplantation, 9 patients have experienced pregnancy and delivery. Clinical courses, the outcome of pregnancy and delivery, and current statuses were retrospectively evaluated from their clinical records. Results: The study revealed 14 pregnancies and 11 deliveries. Before pregnancy, no patient showed visible jaundice, but 6 patients had some complications such as episodes of cholangitis and portal hypertension. Two of the patients had both conditions and 2 others developed visible jaundice after pregnancy. One intrauterine fetal death occurred. Conclusions: Our retrospective review suggests that the previously mentioned conditions can be risk factor for cholangitis and gastrointestinal bleeding during or after pregnancy but are not considered to be contraindications for pregnancy and delivery. Complications can occur with pregnancy even during the normal course. Thus, careful observation is recommended. D 2007 Elsevier Inc. All rights reserved. At present, almost 80% of patients with biliary atresia (BA) become jaundice-free after the Kasai operation [1]. Not all, however, go through life without encountering any serious problems, and only 20% to 30% can reach adulthood without liver transplantation (LTx). Recently, an increasing number of patients live past the age of 20 years without LTx because the outcome of the Kasai operation has markedly improved [2,3]. Even long-term survivors, however, occa- sionally have severe late complications, such as portal hypertension, liver dysfunction, and secondary lung perfu- sion disorders. With the prolongation of life, another serious issue has arisen, that is, how to manage liver function and late complications associated with pregnancy and delivery in female patients [4]. In this study, the clinical courses and current statuses of the patients experiencing pregnancy have been reviewed to elucidate factors affecting liver conditions during and after pregnancy. 0022-3468/$ – see front matter D 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2007.03.027 * Corresponding author. Department of Pediatric Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan. Tel.: +81 22 717 7237; fax: +81 22 717 7240. E-mail address: h-sasaki@ped-surg.med.tohoku.ac.jp (H. Sasaki). Index words: Biliary atresia; Pregnancy; Complications; Liver transplantation Journal of Pediatric Surgery (2007) 42, 1329 – 1332 www.elsevier.com/locate/jpedsurg