06/04/2024
Liver disorders in pregnancy consist of a wide range of diseases arising during gestation and the postpartum period which can result in abnormal liver function tests, hepatobiliary dysfunction, or both. It occurs in 3-10 % of all pregnancies.
Hepatic disorders in pregnancy may be unique to pregnancy, preexisting, or coincident with pregnancy and possibly worsened by pregnancy. Depending on the type of liver disorder in pregnancy, each person will have different signs and symptoms. It might be difficult to treat a liver disorder in pregnancy and requires a multidisciplinary approach.
One of the many difficulties a hepatologist encounters in managing a liver disorder during pregnancy is the unique physiological and anatomical changes that occur during pregnancy, as well as the complex interaction between the mother and the fetus. In addition, potential implications for the fetus and the mother should be considered for various diagnostic and therapeutic approaches.
What Are The Different Liver Disorders In Pregnancy?
The following are the different liver disorders in pregnancy:
- Jaundice: Jaundice may occur from obstetric or non-obstetric conditions. The non-obstetric causes of jaundice include acute viral hepatitis, medications, biliary obstructions by gallstones and acute cholecystitis. The obstetric causes of jaundice include fatty liver of pregnancy, septic abortion, and hyperemesis gravidarum.
- Acute viral hepatitis: Acute viral hepatitis is the most frequent cause of jaundice during pregnancy. The majority of viral hepatitis types (A, B, C, and D) do not change in course during pregnancy; however, hepatitis E may worsen. Although acute viral hepatitis does not seem to be teratogenic, it may increase the risk of preterm delivery.
- Chronic hepatitis: Fertility is hampered by chronic hepatitis, especially when combined with cirrhosis. Prematurity and spontaneous abortion are two risks that are elevated during pregnancy, however maternal mortality is not.
- Intrahepatic cholestasis (pruritus) of pregnancy (ICP): ICP is a liver condition that raises the possibility of problems like excessive postpartum hemorrhage, stillbirth, and early delivery. Premature newborns may require a longer time in the hospital right after birth and are more likely to experience health issues than babies born on time. Fetal discomfort is another element that increases the chance of ICP. This can occur via stillbirth, inhaled meconium after birthing, or insufficient oxygenation of the fetus in the pregnancy. Excessive bleeding after giving birth (postpartum hemorrhage) is an uncommon yet dangerous condition.
- Fatty liver of pregnancy: It is a rare condition which can develop at the end of pregnancy. Liver failure may occur as the condition rapidly gets worse. Severe cases have increased risk factors for maternal and fetal mortality. Doctors may therefore advise an early birth or pregnancy termination in certain situations.
- Hyperemesis Gravidarum: It is a type of morning sickness that typically occurs in the first trimester and is characterized by extreme nausea and vomiting in the patient. Up to 1.5% of pregnant women may have it.
- Liver rupture or hematoma: It usually occurs as a result of severe preeclampsia (high BP during pregnancy).
- Hemolysis, Elevated Liver Enzymes, and Low Platelets Syndrome (HELLP syndrome)
- Biliary disease
- Cirrhosis and hepatic portal hypertension
- Liver transplantation
What Are The Signs And Symptoms Of Liver Disorders In Pregnancy?
The signs and symptoms of liver disorders in pregnancy may vary in different individuals based on the type of liver disease and the severity of the condition they are having. The following are the common symptoms seen in patients with liver disorders in pregnancy, but keep in mind that one may not experience all of these below-listed symptoms.
- Severe nausea and vomiting
- Dehydration
- Malnutrition or poor nutrition
- Yellowing of the skin and eye whites (sclera)
- Loss of hunger
- Lethargy
- Abdominal pain (especially in the right upper quadrant)
- Ascites
- Increased thirst and urination (especially in diabetic patients)
- Itching or pruritus in the skin
- Fever with chills
- Diarrhea
- Headache
- Malaise
- Epigastric pain
- Abdominal distension
- Hepatomegaly
- Gastrointestinal bleeding
- Acute renal failure or liver failure in some patients
How To Diagnose Liver Disorders In Pregnancy?
Diagnosing the underlying cause and extent of liver damage is important for the treatment. The healthcare professional 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 disorders in pregnancy.
Doctors will also suggest a detailed physical examination, and check for high bilirubin levels, elevated transaminase (AST and ALT), creatinine, prothrombin time, serum bile acid levels, serum ammonia levels, serum sodium levels for further treatments.
How To Manage Liver Disorders In Pregnancy?
The management and treatment of liver disorder in pregnancy depends upon the symptoms you are experiencing and the severity of your situation. Common management methods for liver disorders include:
- Medications
- Lifestyle modifications
- Reducing the intake of fatty foods
- Maintaining a healthy body weight
- Including vitamins and other supplements in your diet
- Surgery; in severe cases
Conclusion:
Hepatologists and gynecologists have difficulties when it comes to liver disorders in pregnancy, an issue that has received little research. The difficult aspects include diagnosing the condition and choosing the right course of action to ensure the mother and child's safety. An interdisciplinary approach is warranted due to the complexity of liver disease in pregnancy. Liver disease can cause complications in approximately 3% of pregnancies, and severe liver disorders in pregnancy can be fatal to both the mother and the unborn child. The consequences of both must be taken into account when making diagnostic and treatment decisions.In severe cases, prompt diagnosis is essential because it affects the outcomes for both the mother and the fetus.
It is crucial to differentiate between the two primary types of liver disorder in pregnant women who have been suspected of having it: liver disorders unrelated to pregnancy and the few conditions that are directly linked to pregnancy. The most common cause of liver dysfunction during pregnancy is liver disease related to pregnancy. It's also important to remember that pregnancy is linked to a number of typical physiological changes that should be taken into account when diagnosing liver illness. While non-pregnancy-related liver diseases can develop at any time, pregnancy-related liver disorders show trimester-specific characteristics in their frequency.
If you have been diagnosed with any liver disorders during pregnancy, Visit Eternal Hospital to get the best available treatment and personalized care. Book Your appointment now!
Frequently Asked Questions (FAQs):
Q: What is the most common liver disorder in pregnancy?
A: Intrahepatic cholestasis of pregnancy(ICP) is the most common cause of cholestasis during pregnancy and the most common pregnancy-related liver disorder.
Q: How can you nourish your liver while you're pregnant?
A: For the liver to remain healthy during pregnancy, a balanced diet is essential. Fruits, vegetables, whole grains, lean meats, and healthy fats are among the nutrients that promote liver function. Steer clear of consuming too many processed meals, refined carbohydrates, and harmful fats.