UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

Approach to liver disease occurring during pregnancy

Authors
Richard H Lee, MD
Tram T Tran, MD
Section Editors
Keith D Lindor, MD
Charles J Lockwood, MD, MHCM
Deputy Editors
Kristen M Robson, MD, MBA, FACG
Vanessa A Barss, MD, FACOG

INTRODUCTION

Hepatobiliary disease occurring in a pregnant woman poses a challenge for the consulting clinician. Hepatic abnormalities occurring during pregnancy require diagnosis in the context of expected physiologic changes. In addition, diagnostic and therapeutic decisions have to consider the implications for both the mother and the fetus.

The types and presentation of hepatobiliary disease during pregnancy are varied.

●Some liver diseases are specific to pregnancy (eg, intrahepatic cholestasis of pregnancy and acute fatty liver of pregnancy) and some are multisystemic diseases with hepatic manifestations (eg, preeclampsia). (See "Intrahepatic cholestasis of pregnancy" and "Acute fatty liver of pregnancy" and "Preeclampsia: Clinical features and diagnosis".)

●Pregnancy-related physiologic changes may worsen the severity of, or predispose to hepatobiliary diseases that may also occur in nonpregnant women. Examples include cholelithiasis, thrombotic diseases (such as Budd-Chiari syndrome), and hepatitis E virus infection. (See "Intercurrent hepatobiliary disease during pregnancy".)

●Some diseases are not related to pregnancy but can initially present during pregnancy (eg, acute viral hepatitis). (See "Intercurrent hepatobiliary disease during pregnancy".)

                 

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jun 2017. | This topic last updated: Feb 09, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Riely CA. Liver disease in the pregnant patient. American College of Gastroenterology. Am J Gastroenterol 1999; 94:1728.
  2. ANTIA FP, BHARADWAJ TP, WATSA MC, MASTER J. Liver in normal pregnancy, pre-eclampsia, and eclampsia. Lancet 1958; 2:776.
  3. Bacq Y, Zarka O, Bréchot JF, et al. Liver function tests in normal pregnancy: a prospective study of 103 pregnant women and 103 matched controls. Hepatology 1996; 23:1030.
  4. Potter JM, Nestel PJ. The hyperlipidemia of pregnancy in normal and complicated pregnancies. Am J Obstet Gynecol 1979; 133:165.
  5. Brizzi P, Tonolo G, Esposito F, et al. Lipoprotein metabolism during normal pregnancy. Am J Obstet Gynecol 1999; 181:430.
  6. Ellington SR, Flowers L, Legardy-Williams JK, et al. Recent trends in hepatic diseases during pregnancy in the United States, 2002-2010. Am J Obstet Gynecol 2015; 212:524.e1.
  7. Ch'ng CL, Morgan M, Hainsworth I, Kingham JG. Prospective study of liver dysfunction in pregnancy in Southwest Wales. Gut 2002; 51:876.
  8. Buytaert IM, Elewaut GP, Van Kets HE. Early occurrence of acute fatty liver in pregnancy. Am J Gastroenterol 1996; 91:603.
  9. Knox TA. Evaluation of abnormal liver function in pregnancy. Semin Perinatol 1998; 22:98.
  10. Knight M, Nelson-Piercy C, Kurinczuk JJ, et al. A prospective national study of acute fatty liver of pregnancy in the UK. Gut 2008; 57:951.
  11. 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.
  12. Murali AR, Devarbhavi H, Venkatachala PR, et al. Factors that predict 1-month mortality in patients with pregnancy-specific liver disease. Clin Gastroenterol Hepatol 2014; 12:109.
  13. Sibai BM, Ramadan MK, Usta I, et al. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). Am J Obstet Gynecol 1993; 169:1000.
  14. Bacq Y, Sapey T, Bréchot MC, et al. Intrahepatic cholestasis of pregnancy: a French prospective study. Hepatology 1997; 26:358.
  15. Reau N. Finding the needle in the haystack: predicting mortality in pregnancy-related liver disease. Clin Gastroenterol Hepatol 2014; 12:114.