Liver disease in pregnancy, either pre-existing or pregnancy specific, can be associated with a significant risk of maternal and fetal morbidity and mortality. Here, we review the presentation, management and perinatal outcomes of common causes of liver disease.
Highlights
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We review the presentation, diagnosis and management of liver disease in pregnancy.
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We discuss the perinatal outcomes associated with common liver diseases.
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New-onset vomiting, jaundice or pruritus may indicate liver pathology.
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Prompt diagnosis and treatment may reduce maternal and fetal morbidity and mortality.
Introduction
The liver plays several important roles, including metabolism and excretion of endobiotics, such as cholesterol and bilirubin, and xenobiotics. It also synthesizes several important proteins, for example clotting factors and albumin, and influences bile acid and cholesterol metabolism. The liver moves in normal pregnancy to a more superior and posterior position, but there is little change in liver size in human pregnancy. The normal range of liver function tests alters in normal pregnancy , and several clinical signs that are considered to be pathological in non-pregnant individuals are not of concern in pregnancy. Examples include palmar erythema and the presence of spider naevi.
Hepatic disorders in pregnancy may result from pre-existing liver disease or they can be the result of pregnancy-specific disorders. Liver abnormalities as a result of hypertensive disorders are summarized in Table 1 .
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