Liver diseases unique to pregnancy

Abstract

Liver diseases during pregnancy should be recognized and understood because early diagnosis and specific treatment may improve both maternal and fetal outcomes. Hyperemesis gravidarum which occurs during early pregnancy may be associated with liver dysfunction. Vomiting and biochemical abnormalities improve thanks to intravenous perfusion and vitamins. Pruritus is the main symptom of intrahepatic cholestasis of pregnancy which typically occurs during the second or third trimester. Ursodeoxycholic acid is the most effective medical treatment in improving pruritus and liver tests. Ursodeoxycholic acid therapy might also benefit to fetal outcome. Liver function tests should be performed after delivery, and during oral contraception. Mutations in gene encoding biliary transporters, especially ABCB4 encoding the multidrug resistance 3 protein, have been found to be associated with this complex disease. Acute fatty liver of pregnancy is a rare and potentially fatal disease of the third trimester. Clinicians must have a high index of suspicion for this condition when a woman presents nausea or vomiting, epigastric pain, jaundice, or polyuria-polydipsia during the third trimester. Maternal and fetal prognosis has been radically transformed by early delivery. Acute fatty liver of pregnancy has been found to be associated with fatty acid oxidation defects and mothers and their offspring should undergo DNA testing for the common mutation in the HADHA gene coding subunit long-chain 3-hydroxyacyl coenzyme A dehydrogenase (mutation c.1528G>C). In patients suffering from pre-eclampsia, HELLP syndrome (Hemolysis-Elevated Liver enzymes-Low Platelets) is a life-threatening complication which should discuss early delivery.