Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Mar;130(3):446-461.
doi: 10.1097/ALN.0000000000002597.

Acute Fatty Liver of Pregnancy: Pathophysiology, Anesthetic Implications, and Obstetrical Management

Emily E Naoum  1 , Lisa R Leffert, Hovig V Chitilian, Kathryn J Gray, Brian T Bateman
Affiliations
Review

Acute Fatty Liver of Pregnancy: Pathophysiology, Anesthetic Implications, and Obstetrical Management

Emily E Naoum et al. Anesthesiology. 2019 Mar.
No abstract available

PubMed Disclaimer

Conflict of interest statement

Competing Interests

The authors declare no competing interests.

Figures

Fig. 1.
Fig. 1.
Pathophysiology of acute fatty liver of pregnancy. Impaired mitochondrial β-oxidation of fatty acids caused by enzyme deficiencies has been implicated in the pathogenesis of acute fatty liver of pregnancy. Homozygous fetal enzymatic deficiencies result in increased levels of free fatty acid metabolites that cross into the maternal circulation. Pregnant women who are heterozygous for fatty acid oxidation enzyme defects may be more susceptible to the increased metabolic demands of pregnancy and more susceptible to liver injury from lipotoxic metabolites, inflammatory pathway activation, reactive oxygen species, and apoptosis. The fetal fatty acid oxidation defects that have been associated with acute fatty liver of pregnancy are deficiencies in long-chain acyl-coenzyme A (CoA) dehydrogenases (LCHAD) and mitochondrial trifunctional protein (most common), as well as deficiencies in short-chain acyl-coenzyme A dehydrogenases (SCAD) and medium-chain acyl-coenzyme A dehydrogenases (MCAD)., CPT, carnitine palmitoyltransferase; LCAD, long-chain acyl-coenzyme A dehydrogenase; LKAT, long-chain 3-ketoacyl-coenzyme A thiolase; SCHAD, short-chain 3-hydroxyacyl-coenzyme A dehydrogenase; SKAT, short-chain 3-ketoacyl-coenzyme A thiolase. Figure adapted from Liu J, Ghaziani TT, Wolf JL: Acute fatty liver disease of pregnancy: Updates in pathogenesis, diagnosis, and management. Am J Gastroenterol 2017; 112:838–46 and Treem WR, Rinaldo P, Hale DE, Stanley CA, Millington DS, Hyams JS, Jackson S, Turnbull DM: Acute fatty liver of pregnancy and long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency. Hepatology 1994; 19:339–45.
Fig. 2.
Fig. 2.
Differential diagnosis of liver failure in pregnancy. HELLP, hemolysis, elevated liver enzymes, low platelet count.
Fig. 3.
Fig. 3.
Trajectory of illness.
See this image and copyright information in PMC

References

    1. Liu J, Ghaziani TT, Wolf JL: Acute fatty liver disease of pregnancy: Updates in pathogenesis, diagnosis, and management. Am J Gastroenterol 2017; 112:838–46 - PubMed
    1. Castro MA, Ouzounian JG, Colletti PM, Shaw KJ, Stein SM, Goodwin TM: Radiologic studies in acute fatty liver of pregnancy: A review of the literature and 19 new cases. J Reprod Med 1996; 41:839–43 - PubMed
    1. Ringers J, Bloemenkamp K, Francisco N, Blok JJ, Arbous MS, van Hoek B: Auxiliary or orthotopic liver transplantation for acute fatty liver of pregnancy: Case series and review of the literature. BJOG 2016; 123:1394–8 - PubMed
    1. Nelson DB, Yost NP, Cunningham FG: Acute fatty liver of pregnancy: Clinical outcomes and expected duration of recovery. Am J Obstet Gynecol 2013; 209:456–e1–7. - PubMed
    1. Rolfes DB, Ishak KG: Acute fatty liver of pregnancy: A clinicopathologic study of 35 cases. Hepatology 1985; 5:1149–58 - PubMed

Publication types

Supplementary concepts