Written by David Bernstein, MD, FACP, FACG Friday, 04 December 2009 00:00
The finding of liver test abnormalities during pregnancy creates significant anxiety in both the pregnant woman and the expectant father. This anxiety is made worse by the simple fact that liver disease in pregnancy is poorly understood by many medical practitioners. The good news is that most liver test abnormalities seen in pregnancy resolve on their own with no effect on either the mother or newborn child/children. The cause is usually unknown and tends not to recur with subsequent pregnancies. Despite this reassuring fact, a physician must evaluate liver test abnormalities found during pregnancy as significant liver disease can occur during this period. The most common cause of abnormal liver tests in pregnancy are not specific for pregnancy and are mostly due to viral infections or medication use. There are, however, several important conditions specific for pregnancy that need to be addressed.
Nausea and vomiting are quite common during the first trimester of pregnancy. So common, in fact, that morning sickness is thought to be one of the first signs of pregnancy. Most morning sickness either is easily managed or goes away on its own. Occasionally, the nausea and vomiting will become protracted and severe requiring hospitalization for intravenous fluids. At this stage, morning sickness has evolved into a condition called hyperemesis gravidarum. Abnormalities in liver tests are common in this condition. The development of hyperemesis gravidarum is associated with first pregnancy, young age, smoking and obesity. The cause is unknown. If it is severe and the woman has difficulty maintaining her weight while pregnant, the fetus is at increased risk of intrauterine growth retardation. This condition, however, is not associated with any long-term liver disease.
Intrahepatic cholestasis of pregnancy is a condition unique to both pregnancy and oral contraceptive use and tends to occur in otherwise healthy women. This condition occurs in the third trimester of pregnancy and is marked by the development of severe itching. Liver test abnormalities are common and many patients develop jaundice. The cause is unknown although hormonal changes are felt to play a role in its development. It occurs more commonly amongst people of Latin American or Scandanavian descent. If mild, the itching is treatable with bile-acid resin binders such as cholestyramine. Ursodeoxycholic acid and phenobarbitol have been successfully used to treat itching. The only certain therapy, however, is delivery. With delivery, itching resolves within days and liver test abnormalities usually normalize within several weeks. This is a benign but frequently recurrent condition for the mother. Patients who develop this need to be followed in the future for the development of primary biliary cirrhosis. This condition, however, is not benign for the fetus, as it is associated with an increased rate of fetal distress, premature births and stillbirths.
Two other conditions that are unique to pregnancy are worthy of mention. The HEELP syndrome (hemolytic anemia, elevated liver enzymes and low platelets) and acute fatty of liver of pregnancy are conditions, which occur in the third trimester. The causes for these disorders are unknown but a growing body of research suggests that acute fatty liver of pregnancy may be an inherited disorder. People with these conditions usually complain of fatigue, abdominal pain, headache, nausea or vomiting. Once diagnosed, these conditions need to be treated immediately with delivery as both conditions can rapidly progress to coma and maternal death. Within two weeks of delivery, symptoms generally resolve and the event is self-limited. If delivery goes well, there are no long-term sequelae associated with either condition. Both conditions, however, are associated with an increased risk of maternal death, fetal intrauterine growth retardation and fetal death.
(Disclaimer: The views and opinions represented are those of the author and meant for informative purposes only. For your specific questions, consult your physician.)