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Liver Diseases in Pregnancy

Dr Ifrah Hassan Hilaac February 12, 2026

Liver Diseases in Pregnancy: Causes, Symptoms, Diagnosis, and Management



Pregnancy brings many physiological changes in a woman’s body, including changes in liver function. While mild liver changes may be normal, some liver disorders during pregnancy can pose serious risks to both mother and fetus if not diagnosed and managed early.

Liver diseases in pregnancy may be pregnancy-specific or pre-existing conditions worsened by pregnancy. Understanding these conditions helps ensure early recognition and proper treatment.

Why Does Liver Disease Occur During Pregnancy?

Pregnancy affects liver physiology due to:

  • Hormonal changes (especially estrogen and progesterone)

  • Increased metabolic demand

  • Changes in bile flow

  • Altered immune response

  • Increased blood volume

These changes may trigger liver dysfunction in susceptible women.

Types of Liver Diseases in Pregnancy

1. Intrahepatic Cholestasis of Pregnancy (ICP)

Definition

A reversible liver disorder characterized by impaired bile flow during pregnancy.

When It Occurs

  • Usually in third trimester

  • Most common pregnancy-related liver disease

Symptoms

  • Severe itching (especially palms and soles)

  • No skin rash

  • Dark urine

  • Pale stool

  • Mild jaundice (rare)

Diagnosis

  • Elevated serum bile acids

  • Mildly elevated liver enzymes

Complications

  • Preterm birth

  • Fetal distress

  • Stillbirth (rare but serious)

Management

  • Ursodeoxycholic acid

  • Fetal monitoring

  • Early delivery (often at 37 weeks)

2. HELLP Syndrome

Meaning

HELLP stands for:

  • Hemolysis

  • Elevated Liver enzymes

  • Low Platelets

It is a severe form of preeclampsia.

When It Occurs

  • Third trimester or postpartum

Symptoms

  • Right upper abdominal pain

  • Nausea and vomiting

  • Headache

  • Hypertension

  • Malaise

Complications

  • Liver rupture

  • Disseminated intravascular coagulation (DIC)

  • Maternal mortality

  • Placental abruption

Management

  • Immediate stabilization

  • Blood pressure control

  • Delivery of baby (definitive treatment)

3. Acute Fatty Liver of Pregnancy (AFLP)

Definition

A rare but life-threatening condition caused by fatty infiltration of liver cells.

When It Occurs

  • Third trimester

Risk Factors

  • First pregnancy

  • Multiple pregnancy

  • Male fetus

  • Genetic metabolic disorders

Symptoms

  • Nausea and vomiting

  • Abdominal pain

  • Jaundice

  • Hypoglycemia

  • Confusion

  • Liver failure

Complications

  • Acute liver failure

  • Kidney failure

  • Maternal and fetal death

Management

  • Emergency delivery

  • Intensive care support

4. Preeclampsia with Liver Involvement

Features

  • High blood pressure after 20 weeks

  • Proteinuria

  • Elevated liver enzymes

Symptoms

  • Headache

  • Visual disturbance

  • Epigastric pain

  • Swelling

  • Hypertension

Management

  • Blood pressure control

  • Monitoring

  • Delivery if severe

Liver Diseases Not Specific to Pregnancy

Pregnant women may also develop or already have:

  • Viral hepatitis (A, B, C, E)

  • Gallstones

  • Autoimmune hepatitis

  • Drug-induced liver injury

  • Chronic liver disease

These require specialized management during pregnancy.


Diagnosis of Liver Disease in Pregnancy

Evaluation includes:

  • Liver function tests (ALT, AST, bilirubin)

  • Serum bile acids

  • Complete blood count

  • Coagulation profile

  • Ultrasound

  • Blood pressure monitoring

  • Urine protein assessment

Early diagnosis improves maternal and fetal outcomes.

Effects on Mother and Baby

Maternal Risks

  • Liver failure

  • Bleeding disorders

  • Hypertension complications

  • Kidney failure

  • Death (rare with proper care)

Fetal Risks

  • Preterm birth

  • Growth restriction

  • Fetal distress

  • Stillbirth

Management Principles

Treatment depends on the specific condition but generally includes:

  • Close maternal monitoring

  • Fetal surveillance

  • Symptom control

  • Correction of metabolic abnormalities

  • Timely delivery when necessary

  • Multidisciplinary care (OB-GYN, hepatologist, ICU team)

When to Seek Medical Help

Pregnant women should seek immediate medical care if they experience:

  • Severe itching

  • Yellow eyes or skin

  • Persistent vomiting

  • Severe abdominal pain

  • Headache with high blood pressure

  • Reduced fetal movement

Early intervention can save lives.

Conclusion

Liver diseases in pregnancy range from mild conditions to life-threatening emergencies. Early recognition, proper diagnosis, and timely management are essential to protect both mother and baby. Regular antenatal care and awareness of warning signs play a critical role in preventing complications.


Dr.Ifrah Hassan Hilaac.



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Dr Ifrah Hassan Hilaac

Posted by Dr Ifrah Hassan Hilaac

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