A Systematic Approach to Pregnancy-Specific Liver Disorders

Abstract

Consultation for liver disease during pregnancy is challenging for both the hepatologist and gynecologist, as normal physiologic changes during pregnancy can mimic chronic liver disease. Pregnancy-specific liver disorders are leading causes of abnormal liver function tests during pregnancy. Moreover, up to 3% of all pregnant women in developed countries experience liver diseases nonspecific to pregnancy. When severe, pregnancy-specific liver disorders are associated with significant morbidity and mortality for both the mother and the fetus. The main factors that determine maternal prognosis are the type of liver disease; degree of impaired synthetic, metabolic, and excretory liver function; and timing of delivery. This article focuses on a systematic approach to diagnosing and managing pregnancy-specific liver disorders, which includes understanding normal findings in pregnancy, excluding liver diseases nonspecific to pregnancy, factoring in trimester status, and using clinical clues to make a diagnosis and provide treatment in a timely fashion.

Keywords: Liver disease; acute fatty liver of pregnancy; eclampsia; hyperemesis gravidarum; intrahepatic cholestasis of pregnancy; preeclampsia; pregnancy.

Figure 1.

Timeline of pregnancy-specific liver disorders. HELLP, hemolysis, elevated liver tests, and low platelets.

Figure 2.

Evaluation of a patient suspected of having hyperemesis gravidarum. GI, gastrointestinal; UTI, urinary tract infection.

Figure 3.

Evaluation of a patient suspected of having intrahepatic cholestasis of pregnancy (IHCP).

Figure 4.

Evaluation of a patient suspected of having preeclampsia (PE). Eclampsia is defined as the occurrence of generalized tonic-clonic seizures or coma in a woman with PE.

Figure 5.

Evaluation of a patient suspected of having hemolysis, elevated liver tests, and low platelets (HELLP) syndrome.