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World J Gastroenterol. Nov 21, 2013; 19(43): 7639-7646
Published online Nov 21, 2013. doi: 10.3748/wjg.v19.i43.7639
Liver diseases in pregnancy: Diseases unique to pregnancy
Khulood T Ahmed, Ashraf A Almashhrawi, Rubayat N Rahman, Ghassan M Hammoud, Jamal A Ibdah
Khulood T Ahmed, Ashraf A Almashhrawi, Rubayat N Rahman, Ghassan M Hammoud, Jamal A Ibdah, Division of Gastroenterology and Hepatology, University of Missouri-Columbia, Columbia, MO 65212, United States
Author contributions: Ahmed KT wrote and revised the manuscript; Almashhrawi AA, Rahman RN, and Hammoud GM were involved in reviewing the literature and collecting data; and Ibdah JA conceived the topic, contributed to the writing, analyzed and edited the manuscript, and provided overall intellectual input into the design and execution of the manuscript.
Correspondence to: Jamal A Ibdah, MD, PhD, Professor, Director, Division of Gastroenterology and Hepatology, University of Missouri-Columbia, 319 jesse hall, Columbia, MO 65212, United States. ibdahj@health.missouri.edu
Telephone: +1-573-8827349 Fax: +1-573-8844595
Received: June 10, 2013
Revised: August 5, 2013
Accepted: September 4, 2013
Published online: November 21, 2013
Processing time: 191 Days and 2.7 Hours
Abstract

Pregnancy is a special clinical state with several normal physiological changes that influence body organs including the liver. Liver disease can cause significant morbidity and mortality in both pregnant women and their infants. This review summarizes liver diseases that are unique to pregnancy. We discuss clinical conditions that are seen only in pregnant women and involve the liver; from Hyperemesis Gravidarum that happens in 1 out of 200 pregnancies and Intrahepatic Cholestasis of Pregnancy (0.5%-1.5% prevalence), to the more frequent condition of preeclampsia (10% prevalence) and its severe form; hemolysis, elevated liver enzymes, and a low platelet count syndrome (12% of pregnancies with preeclampsia), to the rare entity of Acute Fatty Liver of Pregnancy (incidence of 1 per 7270 to 13000 deliveries). Although pathogeneses behind the development of these aliments are not fully understood, theories have been proposed. Some propose the special physiological changes that accompany pregnancy as a precipitant. Others suggest a constellation of factors including both the mother and her fetus that come together to trigger those unique conditions. Reaching a timely and accurate diagnosis of such conditions can be challenging. The timing of the condition in relation toward which trimester it starts at is a key. Accurate diagnosis can be made using specific clinical findings and blood tests. Some entities have well-defined criteria that help not only in making the diagnosis, but also in classifying the disease according to its severity. Management of these conditions range from simple medical remedies to measures such as immediate termination of the pregnancy. In specific conditions, it is prudent to have expert obstetric and medical specialists teaming up to help improve the outcomes.

Keywords: Liver; Pregnancy; Hyperemesis gravidarum; Intrahepatic cholestasis; Hemolysis, elevated liver enzymes, and a low platelet count; Preeclampsia; Eclampsia; Acute fatty liver

Core tip: Pregnancy is a special clinical state with several normal physiological changes that influence body organs including the liver. Liver disease can cause significant morbidity and mortality in both pregnant women and their infants. Challenges involve making the diagnosis and the methods of treatment and their safety for both the mother and the baby. This review summarizes liver diseases that are unique to pregnancy.