Helali N, Gagnon H, Álvarez F. Gestational alloimmune liver disease reconsidered: Advocating for a new nomenclature and enhanced diagnosis accuracy. World J Clin Pediatr 2025; 14(4): 106219 [DOI: 10.5409/wjcp.v14.i4.106219]
Corresponding Author of This Article
Fernando Álvarez, MD, Professor, Department of Gastroenterology, Hepatology and Nutrition, CHU Sainte-Justine, 3175 Chem de la Côte-Sainte-Catherine, Montreal H3T1C5, Quebec, Canada. fernando.alvarez@umontreal.ca
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Gastroenterology & Hepatology
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 9, 2025 (publication date) through Oct 31, 2025
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World Journal of Clinical Pediatrics
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Helali N, Gagnon H, Álvarez F. Gestational alloimmune liver disease reconsidered: Advocating for a new nomenclature and enhanced diagnosis accuracy. World J Clin Pediatr 2025; 14(4): 106219 [DOI: 10.5409/wjcp.v14.i4.106219]
World J Clin Pediatr. Dec 9, 2025; 14(4): 106219 Published online Dec 9, 2025. doi: 10.5409/wjcp.v14.i4.106219
Gestational alloimmune liver disease reconsidered: Advocating for a new nomenclature and enhanced diagnosis accuracy
Nourane Helali, Hugo Gagnon, Fernando Álvarez
Nourane Helali, Hugo Gagnon, Fernando Álvarez, Department of Gastroenterology, Hepatology and Nutrition, CHU Sainte-Justine, Montreal H3T1C5, Quebec, Canada
Co-first authors: Nourane Helali and Hugo Gagnon.
Author contributions: Helali N wrote the original manuscript; Helali N and Gagnon H contributed to the conception of the article and conducted the literature review; Gagnon H co-drafted the original manuscript; Álvarez F critically revised the manuscript and validated its scientific content; all authors read and approved the final version.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fernando Álvarez, MD, Professor, Department of Gastroenterology, Hepatology and Nutrition, CHU Sainte-Justine, 3175 Chem de la Côte-Sainte-Catherine, Montreal H3T1C5, Quebec, Canada. fernando.alvarez@umontreal.ca
Received: February 20, 2025 Revised: April 21, 2025 Accepted: June 7, 2025 Published online: December 9, 2025 Processing time: 254 Days and 6.4 Hours
Abstract
Gestational alloimmune liver disease (GALD), previously known as neonatal hemochromatosis, is a rare antenatal immune condition in which maternal antibodies target the fetal liver, leading to a spectrum of liver injury. Although GALD in the leading cause of neonatal liver failure, recent evidence highlights its association with milder phenotypes. A maternal history of miscarriages or stillbirths may be present. GALD is characterized by hepatic and extrahepatic iron overload sparing the reticuloendothelial system. The transferrin saturation coefficient is the most reliable marker of iron overload, and salivary gland biopsy may assist in diagnosis. Early recognition is crucial, as GALD is treatable. Management involves both acute neonatal treatment and preventive strategies for future pregnancies. Recurrence may reach 90% but can be effectively prevented with antenatal intravenous immunoglobulin therapy. We report four cases of GALD managed in gastroenterology unit of the Sainte-Justine center in Montreal, Canada. A literature review was also conducted to explore the etiopathogenesis, diagnosis, treatment options, and outcomes of the GALD. A total of 39 studies published between 2008 and 2024 were identified through PubMed, Google Scholar, and EMBASE using the terms “gestational alloimmune liver disease” and “neonatal hemochromatosis”.
Core Tip: Gestational alloimmune liver disease is a rare neonatal hepatic condition with clinical manifestations ranging from benign presentations to fulminant liver failure. Curative treatments include intravenous immunoglobulin (IVIG) and double-volume plasma exchange; liver transplantation may be necessary in severe cases. The recurrence rate in subsequent pregnancies is as high as 90%, but it can be effectively prevented with antenatal IVIG administration. In this review, we summarize the latest available literature to raise awareness among pediatricians and pediatric hepatologists, ensuring early recognition and appropriate management of this condition.
