Liver Disease and Pregnancy

Depending on the type of liver illness a pregnant woman may have, several symptoms may be present:

Hyperemesis gravidarum (HG): Nausea and vomiting
Acute fatty liver of pregnancy (AFLP): Progress quickly to FHF, diabetes insipidus, hypoglycemia
Intrahepatic cholestasis of pregnancy (ICP): Pruritus; resolves in postpartum period
Hemolysis and elevated liver enzymes and low platelets (HELLP) syndrome: pain, seizures, renal failure, pulmonary edema, liver hematoma and rupture
Although there are no specific signs or symptoms of liver illness during pregnancy, the underlying condition can have serious consequences for the mother and fetus in terms of morbidity and death.

Book an appointment with your gynaecologist right away if you experience any of these symptoms. He might refer you to a hepatology doctor for case further management.

Each liver disease that might be brought on by pregnancy has a number of risk factors associated with it:

Hyperemesis gravidarum (HG): a history of the condition, hyperthyroidism, mental illness, numerous gestations, multiparity, an elevated body mass index, and a large intake of saturated fat daily before becoming pregnant.
Factors increase the risk of developing acute fatty liver of pregnancy (AFLP) include older maternal age, primiparity, multiple gestations, preeclampsia, male foetus, being underweight, and a history of AFLP.
Intrahepatic cholestasis of pregnancy (ICP) has multiple risk factors including pre-existing liver disease, advanced maternal age, , many pregnancies, personal or family history of the condition, and a history of cholestasis when using oral contraceptives
Haemolysis and elevated liver enzymes and low platelets (HELLP) syndrome have risk factors of white race/ethnicity, nulliparity, older age, and preeclampsia are associated with haemolysis, increased liver enzymes.

Women with abnormal liver tests should undergo further evaluation workup:

Ultrasonography is a safe and preferred imaging modality for evaluating abnormal liver studies that may indicate biliary tract disease.
Gadolinium-enhanced magnetic resonance imaging (MRI) can be used in the second and third trimesters.
CT scans pose a risk of teratogenesis and childhood hematologic malignancies, but they can be used safely with low-dose radiation protocols (2-5 rads).
Endoscopy is safe during pregnancy, but it should be avoided if possible until the second trimester. Endoscopic sedation with meperidine and propofol is possible.
A liver biopsy may be required for diagnosis in some cases.
Early recognition can be lifesaving in liver biopsy.

Treatment medications and management interventions differ depending on the type of liver disease a pregnant woman has:

Hyperemesis gravidarum (HG): intravenous fluids, thiamine pyridoxine, and promethazine; FDA category C.
AFLP (acute fatty liver of pregnancy): immediate delivery; liver transplantation
ICP (intrahepatic cholestasis of pregnancy): Ursodiol; delivery when foetal distress is imminent
HELLP (haemolysis, elevated liver enzymes, and low platelets) syndrome: Prompt delivery
To promote good maternal and foetal outcomes, a coordinated team approach involving the gynaecologist, hepatology doctor, and transplant surgeon is frequently required.