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
. 2021 Jul;17(7):322-329.

A Systematic Approach to Pregnancy-Specific Liver Disorders

Dhruv Verma  1 , Adelaide M Saab  2 , Sammy Saab  1   2 , Mohamed El-Kabany  1   2
Affiliations

A Systematic Approach to Pregnancy-Specific Liver Disorders

Dhruv Verma et al. Gastroenterol Hepatol (N Y). 2021 Jul.

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.

PubMed Disclaimer

Conflict of interest statement

Disclosures: The authors have no relevant conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Timeline of pregnancy-specific liver disorders. HELLP, hemolysis, elevated liver tests, and low platelets.
Figure 2.
Figure 2.
Evaluation of a patient suspected of having hyperemesis gravidarum. GI, gastrointestinal; UTI, urinary tract infection.
Figure 3.
Figure 3.
Evaluation of a patient suspected of having intrahepatic cholestasis of pregnancy (IHCP).
Figure 4.
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.
Figure 5.
Evaluation of a patient suspected of having hemolysis, elevated liver tests, and low platelets (HELLP) syndrome.
See this image and copyright information in PMC

References

    1. Mikolasevic I, Filipec-Kanizaj T, Jakopcic I et al. Liver disease during pregnancy: a challenging clinical issue. Med Sci Monit. 2018;24:4080–4090. - PMC - PubMed
    1. Westbrook RH, Dusheiko G, Williamson C. Pregnancy and liver disease. J Hepatol. 2016;64(4):933–945. - PubMed
    1. Kamimura K, Abe H, Kawai H et al. Advances in understanding and treating liver diseases during pregnancy: a review. World J Gastroenterol. 2015;21(17):5183–5190. - PMC - PubMed
    1. Shekhar S, Diddi G. Liver disease in pregnancy. Taiwan J Obstet Gynecol. 2015;54(5):475–482. - PubMed
    1. Meah VL, Cockcroft JR, Backx K, Shave R, Stöhr EJ. Cardiac output and related haemodynamics during pregnancy: a series of meta-analyses. Heart. 2016;102(7):518–526. - PubMed

LinkOut - more resources