Liver disease during pregnancy includes a series of disorders that occur during pregnancy and postpartum which causes abnormal liver function and hepatobiliary dysfunction. About 3-10 percent of women face some form of liver problems during pregnancy.

Certain liver disorders are only associated with pregnancy and are caused by already existing conditions that get escalated during pregnancy. Liver disorders specific to pregnancy include;

* Hyperemesis gravidarum
* Acute fatty liver of pregnancy (AFLP)
* Intrahepatic cholestasis of Pregnancy (IPC)
* Hemolysis and elevated liver enzymes, and low platelets (HELLP) syndrome.

There are also certain liver-related issues such as viral hepatitis that are not associated with pregnancy in any way, but can affect pregnant women.

What causes liver problems during pregnancy?

The causes of liver disease during pregnancy cannot be specified as there may be several factors and underlying conditions behind. Some of the symptoms of liver disease during pregnancy are severe itching of the limbs, nausea, loss of appetite, extreme fatigue, dark urine, and even depression.

Intrahepatic Cholestasis of Pregnancy or other liver diseases in pregnant women can affect babies in uterus, and cause elevated levels of bile that can stress the foetus. Liver disease can even lead to premature birth or stillbirth, depending on its severity.

Most common conditions and the risk factors of liver diseases during pregnancy

1. Hepatitis:

Acute viral hepatitis can increase the risk of pre-term birth. It is also the main cause of jaundice during pregnancy. During pregnancy, most types of hepatitis are not that severe, but Hepatitis E can be severe during pregnancy and cause complications. After birth in rare cases, the infant can be infected with Hepatitis B. Women with chronic hepatitis may face problems with pregnancy, especially if cirrhosis is present, they are more likely to have a miscarriage or premature birth. In severe cases, women with chronic hepatitis may be given antiviral drugs in the third semester. These drugs can reduce the risk of hepatitis virus infecting the fetus.

2. Fatty liver during pregnancy:

This rare condition can develop at the end of pregnancy. The disorder quickly worsens and can develop liver failure. The cause is unknown, and symptoms of the fatty liver during pregnancy include nausea, vomiting, abdominal discomfort, and jaundice. Risk factors for mortality in pregnant women and fetuses are higher in severe cases. Therefore, doctors may recommend immediate delivery or termination of pregnancy in such cases.

3. Intrahepatic Cholestasis of Pregnancy (IPC):

ICP is a liver disease that can increase the risk of problems such as premature birth, stillbirth, and excessive postpartum bleeding. Children born prematurely are exposed to more health problems and can have longer hospital stays immediately after birth than babies born around the due date. Another risk factor for IPC is fetal distress. This happens when the baby does not get enough oxygen in the womb, stillbirth, or inhaled meconium during childbirth. Postpartum hemorrhage is a rare and serious condition.

Diagnosis of liver diseases during pregnancy

Finding the cause and extent of liver damage is important for the treatment. The doctor will probably start with a medical history and then do a thorough physical examination. Doctors propose a set of tests including blood tests, and liver function tests to diagnose liver diseases.

Doctors will also suggest a physical examination, and check for high bilirubin levels, elevated transaminase, and serum bile acid levels for further treatments. The doctor may suggest liver transplant and if the cases are severe they may suggest abortion in the first trimester.

The last word

Even if the signs or symptoms of the liver disease are not clearly present during pregnancy, it can cause a significant impact on maternal and fetal morbidity and mortality, if undetected. Early detection of liver disease can save the lives of both the mother and the child.

Fertility can be restored after a liver transplant, and pregnancy can have positive consequences. It’s a general thought that the chances of a recurrence of liver disease are very high. In any case, regular visits to a doctor and frequent prenatal and postnatal health checks will help ensure that the pregnancy is safe and healthy for both the mother and the child.