A population-based study of acute fatty liver of pregnancy: incidence and maternal and neonatal outcomes

Abstract

NANCY: INCIDENCE AND MATERNAL AND NEONATAL OUTCOMES ROSA H. WON, SHERRIE S. MCELVY, BEATE DANIELSEN, WILLIAM M. GILBERT, University of California, Davis, OB/GYN, Sacramento, CA Health Information Solutions, Rocklin, CA OBJECTIVE: Acute fatty liver of pregnancy (AFLP) is a rare and serious complication historically associated with significant maternal and neonatal sequelae. The literature on AFLP is largely limited to case studies. We sought to determine pregnancy outcomes in a large population of women with AFLP. STUDY DESIGN: In this population-based retrospective cohort study, all cases of AFLP identified from the linked California birth certificate and hospital discharge database from 1991-2000 were included. Odds ratios (OR) were determined and compared. RESULTS: There were 2211 cases of AFLP identified over a 10-year period, for an incidence of 1 in 1666. Women in the AFLP group were older (>41 years) (OR 3.2; 95%CI 1.1, 1.4),more likely of Asian race (OR 8.3; 7.4, 9.3),more likely to have a college degree (OR 1.2; 1.1, 1.4), and more likely to be hepatitis B carriers (OR 94.7; 77.2, 116.0) than the population at large. Adverse maternal outcomes includedmaternal death (OR 21.4; 8.9, 51.7), acute renal failure (OR 48.7; 29.6, 80.2), mechanical ventilation for > 96 hours (OR 49.8; 28.6, 86.5), and DIC (OR 35.4; 18.3, 68.5). Neonatal outcomes in the AFLP group showed increased prematurity (OR 2.4; 2.1, 2.7) and birthweight < 1500 grams (OR 2.3; 1.7, 3.1), but neonatal death was not significantly different compared to the population at large. CONCLUSION: AFLP continues to have significant maternal morbidity and mortality, while neonatal survival has improved over historical reports. Hepatitis B carriers may be predisposed to AFLP, suggesting a possible cause.