Advances in understanding and treating liver diseases during pregnancy: A review

Abstract

Liver disease in pregnancy is rare but pregnancy-related liver diseases may cause threat to fetal and maternal survival. It includes pre-eclampsia; eclampsia; haemolysis, elevated liver enzymes, and low platelets syndrome; acute fatty liver of pregnancy; hyperemesis gravidarum; and intrahepatic cholestasis of pregnancy. Recent basic researches have shown the various etiologies involved in this disease entity. With these advances, rapid diagnosis is essential for severe cases since the decision of immediate delivery is important for maternal and fetal survival. The other therapeutic options have also been shown in recent reports based on the clinical trials and cooperation and information sharing between hepatologist and gynecologist is important for timely therapeutic intervention. Therefore, correct understandings of diseases and differential diagnosis from the pre-existing and co-incidental liver diseases during the pregnancy will help to achieve better prognosis. Therefore, here we review and summarized recent advances in understanding the etiologies, clinical courses and management of liver disease in pregnancy. This information will contribute to physicians for diagnosis of disease and optimum management of patients.

Keywords: Acute fatty liver of pregnancy; Haemolysis elevated liver enzymes; Hyperemesis gravidarum; Intrahepatic cholestasis of pregnancy; Liver injury; Low platelets; Pregnancy.

Figure 1

Clinical course of intrahepatic cholestasis of pregnancy. UDCA: Ursodeoxycholic acid; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; T-Bil: Total bilirubin. Reconstructed from ref [19] with permission.

Figure 2

Clinical course of haemolysis, elevated liver enzymes, and low platelets syndrome syndrome. AST: Aspartate aminotransferase; PLT: Platelet.