WD Treatment During Pregnancy and Breastfeeding
It is very important to continue treatment for Wilson disease in patients who are pregnant to avoid worsening of liver disease or development or worsening of neurological symptoms. To protect the fetus, it is necessary to pick treatments that have the lowest risk of fetal complications, but support and enhance fetal growth and development.
Patients on zinc for WD treatment whose liver function and neurological disease are stable need not reduce their dose of zinc when preparing to conceive or during pregnancy. Switching from chelation therapy to zinc prior to pregnancy is an option if there are concerns about continuing chelation during the pregnancy. However, switching from chelation to zinc during pregnancy is not advised because the patient may not tolerate zinc well due to possible increased issues of reflux and dyspepsia that are common during pregnancy.
Patients being treated with a chelator like penicillamine or trientine should be considered for dose reduction as soon as possible, even in anticipation of a pregnancy, to reduce risk to the fetus of copper deficiency or teratogenicity. Thus, female patients who are trying to get pregnant should consult their doctor about reducing dosage of a chelator. If the dose is reduced, monitoring of WD treatment should be done more frequently while taking a lower dose. On average, a 30% to 50% dose reduction and monitoring every 3 to 4 months is recommended. After delivery, if no surgical procedures were involved, the patient can return to the dose taken before pregnancy. If a surgery was performed at delivery, it is best to continue the reduced dosage until wound healing is complete.
Currently, due to lack of supporting scientific evidence, breastfeeding while on WD treatment with either chelators or zinc is not recommended, even though there are some reports of no adverse effects on infants breastfed while the mother is on WD treatment.
Resources
Dr. Peter Ott”s presentation on pregnancy with Wilson disease given at the Wilson Disease Association conference in December of 2020.
