Advances in understanding and treating liver diseases during pregnancy: A review

Table 1 Classification of pregnancy-related liver disease

	HG	ICP	Hypertension-related liver diseases and pregnancy		AFLP
			Pre-eclampsia, Eclampsia	HELLP
Time (trimester)	1	2 and 3	3	3	3
Frequency (%)	0.3-2.0	0.1-1.5	5-10	0.2-0.6	0.01
Clinical features	Nausea	Pruritis	High BP	High BP	Nausea
	Vomiting	Mild jaundice	Edema	Edema	Vomiting
	Dehydration	Mild elevation of transaminase	Proteinuria	Proteinuria	Hypoglycemia
		Elevation of bile acids	Seizure	Seizure	Lactic acidosis
			Mild elevation of transaminases	DIC	Severe elevation of transaminases
				Mild to severe elevation of transaminases
Pathogenesis -physiologic	starvation, gastric motility, hormonal factors, psychological factors	Hormonal factors	Capillary thrombi, fibrin deposition, endothelial dysfunction, coagulation activation		Microvascular fatty infiltration
Pathogenesis -molecular components	Genetic mutation of LCHAD, Palmitoyltransferase I deficiency	Genetic mutation of MDR3, BSEP	Vascular remodeling, fatty acid oxidation, and immunological factors		Genetic mutation of LCHAD
Managements	Supportive, Hydration	UDCA	BP control	Prompt delivery	Prompt delivery
					Plasmapheresis
					Liver transplantation
Recurrence	Often	50%-70%	rare	rare	higher ratio with genetic mutation in LCHAD

HG: Hyperemesis gravidarum; ICP: Intrahepatic cholestasis of pregnancy; HELLP: Haemolysis, elevated liver enzymes, and low platelets; AFLP: Acute fatty liver of pregnancy; BP: Blood pressure; DIC: Disseminated intravascular coagulation; LCHAD: Long-chain 3-hydroxyl coenzyme A dehydrogenase; MDR3: Multidrug resistance protein; BSEP: Bile salt export protein.