Acute fatty liver of pregnancy
- Richard H Lee, MD
Richard H Lee, MD
- Assistant Professor of Clinical Obstetrics and Gynecology
- Division of Maternal Fetal Medicine
- Keck School of Medicine of the University of Southern California
- Tram T Tran, MD
Tram T Tran, MD
- Medical Director of Liver Transplantation
- Liver Disease and Transplant Center at Cedars-Sinai.
- Section Editors
- Keith D Lindor, MD
Keith D Lindor, MD
- Section Editor — Alcoholic and Metabolic Liver Disease
- Professor of Medicine, Mayo Clinic College of Medicine
- Dean, College of Health Solutions
- Arizona State University
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
Acute fatty liver of pregnancy, characterized by microvesicular fatty infiltration of hepatocytes, is a disorder which is unique to human pregnancy . It was described in 1940 and was initially thought to be universally fatal . However, early diagnosis and prompt delivery have dramatically improved the prognosis, and maternal mortality should now be the exception rather than the rule .
The major clinical features of acute fatty liver of pregnancy will be reviewed here. A general approach to the pregnant woman who develops liver disease is presented elsewhere and has also been addressed in a guideline issued by the American College of Gastroenterology (table 1) . (See "Approach to liver disease occurring during pregnancy".)
Acute fatty liver of pregnancy is rare, with an approximate incidence of 1 in 7000 to 1 in 20,000 deliveries [4-8]. It is more common with multiple gestations and possibly in women who are underweight.
One of the largest population-based studies included 1,132,964 pregnancies at 229 hospitals in the United Kingdom between 2005 and 2006 . There were a total of 57 women diagnosed with acute fatty liver of pregnancy (5 cases per 100,000 pregnancies, 95% CI 3.8-6.5). Of these, 18 percent of women had twin pregnancies and 20 percent were underweight (body mass index <20).
Acute fatty liver occurs typically in the third trimester. The disease is always present before delivery, although it is not always diagnosed prior to delivery.
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