Liver disease in pregnancy
- Topic
Three liver disorders are tied to pregnancy; two can quickly threaten mother and baby and resolve with delivery.
What it is
Abnormal liver tests in pregnancy may come from ordinary liver disease or from disorders unique to pregnancy. Preeclampsia and its HELLP variant cause periportal fibrin deposition, hemorrhage and necrosis; acute fatty liver of pregnancy causes microvesicular steatosis and can lead to acute liver failure; intrahepatic cholestasis of pregnancy causes itching and bland cholestasis. The first two are obstetric emergencies treated by delivery.
Step by step
- Preeclampsia: an abnormal placenta releases anti-angiogenic factors that injure maternal endothelium.
- Endothelial injury in liver sinusoids causes fibrin deposition and periportal hemorrhage and necrosis.
- Acute fatty liver: a fetus with a fatty acid oxidation defect sends toxic metabolites to the mother.
- Maternal hepatocytes accumulate tiny fat droplets and fail.
- Cholestasis of pregnancy: high estrogen and progesterone metabolites inhibit bile transporters in genetically susceptible women.
Liver disorders unique to pregnancy
| Disorder | Timing | Pathology | Key features |
|---|---|---|---|
| Preeclampsia and HELLP | Late second or third trimester, or after delivery | Periportal fibrin, hemorrhage and necrosis | Hypertension, hemolysis, low platelets, risk of hepatic rupture |
| Acute fatty liver of pregnancy | Third trimester | Microvesicular steatosis, often zone 3, little necrosis | Liver failure, hypoglycemia, coagulopathy; fetal LCHAD deficiency |
| Intrahepatic cholestasis of pregnancy | Second half of pregnancy | Bland canalicular cholestasis | Pruritus, high bile acids; preterm birth and fetal distress |
| Hyperemesis gravidarum | First trimester | Mild, non-specific changes | Vomiting, mild enzyme rise |
Test yourself
Think of the answer, then tap the question to see it.
What does HELLP stand for?
Hemolysis, Elevated Liver enzymes and Low Platelets, a severe form of preeclampsia.
What type of steatosis is seen in acute fatty liver of pregnancy?
Microvesicular steatosis, linked to fetal defects of mitochondrial fatty acid oxidation such as LCHAD deficiency.
What is the main symptom of intrahepatic cholestasis of pregnancy?
Pruritus, often of the palms and soles, with raised serum bile acids.
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Intrahepatic cholestasis of pregnancy: MedlinePlus Genetics (MedlinePlus, US National Library of Medicine, 2026); Long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency: MedlinePlus Genetics (MedlinePlus, US National Library of Medicine, 2026).
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Representative model, for educational purposes only.