Liver disease in pregnancy

Although not common, liver disease can occur in pregnant women. The following diseases are unique to pregnancy and not comparable to those occurring in non-pregnant patients. Direct causes of any of these conditions are unknown.

Acute fatty liver of pregnancy (AFLP)

Acute fatty liver of pregnancy (AFLP) is a serious condition that occurs in the third trimester of pregnancy.  It occurs in 1 in 13,000 pregnancies.  Although rare, AFLP can lead to liver failure and encephalopathy (mental confusion and coma).  If diagnosis is made in the later stages of disease, the fetus and mother could both die.  Recent studies have shown a maternal mortality rate of 10-20% with AFLP which indicates a need for better understanding of the disease in order to make an early diagnosis and treatment.  Symptoms of AFLP include fatigue, nausea, vomiting and abdominal pain.  Jaundice (yellow pigmentation of the skin) can occur as the disease progresses.  Emergency delivery of the of the baby can often reverse liver damage.

Intrahepatic cholestasis of pregnancy

Some women experience a very severe itching (pruritus) in late pregnancy (often begins on the palms of the hands and the soles of feet and can become generalized). Cholestasis is an inability of the liver to excrete bile. Intense severe itching is due to bile salts that are deposited in the skin. In cholestasis of pregnancy the normal flow of bile in the gallbladder is affected by the high amounts of pregnancy hormones. Cholestasis is more common in the last trimester of pregnancy when hormones are at their peak, but it usually goes away within a few days after delivery. Cholestasis occurs in about 1 out of 1,000 pregnancies. It is sometimes referred to as extrahepatic cholestasis which occurs outside the liver, intrahepatic cholestasis which occurs inside the liver, or obstetric cholestasis.
 

Preeclampsia

Preeclampsia is a condition characterized by high blood pressure, proteins in urine, swelling, sudden weight gain and headaches.  The liver is also affected because it becomes inflamed as evident by elevated levels of liver enzymes.

HELLP Syndrome (Hemolysis, Elevated Liver tests, Low Platelets)

HELLP Syndrome (Hemolysis, Elevated Liver tests, Low Platelets) a condition involving hemolysis (anemia), elevated liver enzymes  and low platelets (clotting factors).The clinical and biochemical characteristics of HELLP overlap significantly with AFLP.  The cause of this condition is not known and it occurs in about 4-20% of women with severe pre-eclampsia.  

Other liver diseases that may affect pregnant women

In addition to the diseases unique to pregnancy, pregnant women are also susceptible to viral infections such as acute hepatitis A, B, C, E. Out of these four viruses, only hepatitis B and C can lead to chronic disease, and therefore could be pre-existing.  Hepatitis A and hepatitis E do not lead to chronic hepatitis.There are safe and effective vaccines against hepatitis A and B only but are not usually administered during pregnancy. Pregnant women have to be careful not to become infected during pregnancy. Both hepatitis A and E are transmitted  through contaminated food and water (via the fecal-oral route).  Hepatitis A outbreaks may occur in Canada, although the virus is more prevalent in third world and tropical countries and may be greater risks when traveling abroad.  Hepatitis E is common in India and is known to cause high mortality rates in pregnant women.

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