Abnormal liver function blood tests occur in 3 to 5 percent of pregnant women, gastroenterologist J. Eileen Hay of the Mayo Clinic reports in the March 2008 issue of "Hepatology." While previous liver disease such as hepatitis or gallbladder problems can affect pregnant women, most problems with the liver in pregnancy occur from one of five types of liver dysfunction associated with pregnancy, Hay further notes. Conditions not related to pregnancy can also cause liver problems in pregnancy.
Pregnancy-Related Liver Disease
Liver problems specifically related to pregnancy fall into one of two general classes, Hay states: those associated with preeclampsia, a condition characterized by a rise in blood pressure, edema and protein in the urine, and those not associated with preeclampsia. Diseases associated with preeclampsia include preeclampsia itself, which affects 5 to 10 percent of pregnancies, according to Hay; acute fatty liver of pregnancy, which affects 1 in 10,000 to 15,000 pregnancies, the March of Dimes reports; and HELLP syndrome, which affects less than 1 percent of pregnant women. HELLP stands for hemolysis, elevated liver test and low platelet levels.
The two diseases not associated with preeclampsia are hyperemesis gravidarum, intractable vomiting which affect 0.3 percent of pregnancies, in the first trimester of pregnancy and intrahepatic cholestasis of pregnancy, or ICP, which affects less than 1 percent of pregnant women and causes itching due to elevated bile acids and liver enzymes with mild jaundice, according to the March of Dimes.
Non Pregnancy-Related Liver Disease
Hepatitis A, B or C can all affect pregnancy and can develop before or during pregnancy. Hepatitis A doesn't normally cause problems with the fetus, although hepatitis B is passed on to the fetus in 10 to 20 percent of pregnancies and hepatitis C is transmitted before birth in 4 percent, the March of Dimes warns.
Symptoms
Symptoms of liver disease in pregnancy vary depending on the cause. Jaundice, a yellow tinge to the skin and whites of the eyes, can occur in any type of liver disease in pregnancy. Severe nausea and vomiting occur in hyperemesis gravidarum and can also occur in acute fatty liver of pregnancy, preeclampsia and HELLP, along with abdominal pain. Malaise, headache and confusion can occur in women with HELLP, preeclampsia or acute fatty liver.
Treatment
The treatment for HELLP, acute fatty liver and preeclampsia is delivery of the fetus. Medications to lower blood pressure and prevent seizures may also be given in HELLP and preeclampsia. Because the chance of stillbirth is also increased in ICP, early delivery may be recommended. Treatment with Actigall helps decrease severe itching. Antiemetic medications and fluid replacement are used to treat hyperemesis gravidarum. Babies born to women with hepatitis B should receive vaccines to reduce the chance of developing the infection.
Recurrence
Many women remain at high risk for recurrence of liver disease during subsequent pregnancies. ICP recurs in 45 to 70 percent of subsequent pregnancies, while HELLP recurs in 4 to 19 percent and acute fatty liver disease in 9 to 23 percent, Hay reports. Hyperemesis gravidarum often occurs in subsequent pregnancies as well, the National Organization for Rare Disorders reports. Preeclampsia recurs in 40 percent of those who deliver before 28 weeks and in 13 percent those who deliver at term, the March of Dimes states.
