Acute fatty liver of pregnancy
Liver disease in pregnancy
Pregnancy related liver disease represents a challenging problem. Often, there is overlap between many of the individual conditions. In general, if any of the following conditions have occurred in one pregnancy, there is a high likelihood of occurrence in a subsequent pregnancy.
Acute fatty liver of pregnancy occurs in approximately one in 10,000 pregnancies but varies worldwide. In Europe, there is a genetic predisposition in the Baltic area so the frequency of this condition in this area may be more common.
It presents with vomiting, low blood sugar, confusion and fat accumulation in the liver, kidneys and other organs in its most severe form. It typically occurs after week 28. It is more common in first or twin pregnancies. It is associated with high blood pressure in pregnancy (pre-eclampsia) in 50%.
It is associated with a genetic abnormality in the baby where there is build up or accumulation of long chain fatty acids. These accumulate in the mother’s circulation primarily because the mother is also a carrier of the a genetic variant. Often however, despite a genetic predisposition being suspected, it is not possible to identify a cause.
Management involves multidisciplinary care with liver specialists and obstetricians working closely together. Often, it takes four weeks for the liver blood test abnormalities to resolve. It tends to recur again in subsequent pregnancies.