Liver Problems in Pregnancy

Liver disease can cause a variety of problems in pregnancy and result in abnormal liver function tests (LFT) or hepatobiliary dysfunction. About 3% to 10% out of all pregnant women develop some sorts of liver problem. Whenever the liver disease is present, it demands serious attention because it can cause serious complications during pregnancy.

Liver Problems and Treatment Options in Pregnancy

It is important to see your doctor whenever you notice symptoms like severe fatigue, nausea, etc., during pregnancy. Your doctor will order tests to confirm the diagnosis and determine a treatment option considering the liver problem you have.

1. Intrahepatic Cholestasis of Pregnancy (ICP)

It is one of the most common liver problems in pregnancy. This pregnancy related liver disorder leads to abnormalities in the flow of bile. The liver produces bile to help improve the absorption and digestion of fats. ICP leads to a buildup of bile acids in your blood that can be dangerous for your growing baby and even make you deal with issues such as severe itching and jaundice.

Treatment

Your doctor may opt for different treatment options considering the severity of the symptoms. For instance:

  • They may prescribe a medication called ursodeoxycholic acid to help relieve severe skin itching. It also improves liver function and lowers the risk of stillbirth.
  • Your doctor may order ultrasound and other tests to keep a close eye on your baby's heart rate. They often recommend early delivery in case your baby has heart rate abnormalities. They usually perform a test called amniocentesis if you are 36 weeks pregnant. This helps ensure that the lungs of babies are mature, and only then the doctor can induce labor.

2. Acute Fatty Liver of Pregnancy (AFLP)

As one of the most serious liver problems in pregnancy, this condition usually affects pregnant women during the third trimester of pregnancy. It is a rare condition though, affecting only 1 in 13,000 pregnancies, but it can cause serious complications. It may lead to liver failure, as well as encephalopathy which results in mental confusion and coma. If not detected earlier, the fetus and mother could die. The most common symptoms of AFLP include nausea, fatigue, abdominal pain, and vomiting. Some women may also develop jaundice.

Treatment

AFLP requires immediate medical attention because any delay can result in life-threatening complications. You will be admitted to the hospital where your doctor will constantly monitor the condition of your baby. The only treatment option is to induce early labor because the delivery may help lower the load of fatty acids on your liver. After delivery, it may take 48-72 hours to feel better. In case your symptoms do not improve after 72 hours of delivery, you may need a liver transplant.

3. Preeclampsia

Preeclampsia can cause elevated liver enzyme and may also leave you with liver swelling. It is among the most serious liver problems in pregnancy, and it usually affects you during the third trimester of pregnancy. The most common symptom is elevated blood pressure. When left untreated, preeclampsia results in stroke, seizures, and even death of the mother or baby. It is therefore important to seek immediate medical attention to prevent liver damage.

Treatment

It is important to take steps to prevent any damage to the liver and one effective way is to induce early labor. In case you develop preeclampsia too early in your pregnancy, your doctor may give you medications to lower your blood pressure. Anticonvulsant medications and corticosteroids may also help alleviate symptoms.

4. Acute Viral Hepatitis

Caused by a virus, hepatitis can lead to several complications during pregnancy. This liver condition is not exclusive to pregnant women only, and you can contract the infection even when you are not pregnant. There are three main strains of hepatitis: Type A, B, and C. When you get it during pregnancy, you end up dealing with several liver problems. The hepatitis B can even affect the fetus. Some of the most common complications of acute viral hepatitis are abdominal discomfort, fatigue, jaundice, and a fever. Not seeking treatment may lead to liver failure, liver disease, and liver cancer.

Treatment

Your doctor will first identify the strain of hepatitis you have and then determine the best treatment accordingly. For instance:

  • For Hepatitis A: When you have symptoms caused by hepatitis A, you need to pay attention to adequate hydration and nutrition. You may have to take immune globulin when you become infected during pregnancy. It is given within two weeks of exposure along with vaccine.
  • For Hepatitis B: If you have HBsAg-positive, your baby should receive hepatitis B immune globulin immunoprophylaxis soon after delivery. They should also get hepatitis B vaccine at 1 week, 1 month, and 6 months of age. This helps lower the risk of developing hepatitis B for babies.
  • For Hepatitis C: There is no therapy to affect the neonatal transmission of hepatitis C virus. Interferon is an option, but you cannot take it during pregnancy because of its negative effects on the fetus.

5. HELLP Syndrome

Among many liver problems in pregnancy, one serious disorder is HELLP syndrome. In this condition, you develop anemia, low platelets, and elevated liver enzymes. You are more likely to develop it during your third trimester and it can also develop postpartum. It can lead to several complications and result in liver damage as well as kidney failure. Bleeding problems, stroke, and death are other possible consequences.

Treatment

You are likely to go into early labor because the delivery of the baby is the only treatment here. Immediate delivery is usually essential because the syndrome has a very rapid onset. Your doctor may order a blood test to confirm the diagnosis, and if you have it, it is important to deliver the baby as soon as possible. Certain drugs are available to help postpone the delivery for up to 48 hours if you are at less than 34 weeks' pregnant and these drugs can help develop your baby's lungs. 

 
 
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