Pre-existing and Pregnancy-Induced Liver Disease

, University of Colorado Health Sciences Center.


Medscape General Medicine. 1998;1(3) 

In This Article

Abstract and Introduction


In Distinguishing Normal From Abnormal Hepatic Changes, the author described the expected changes in liver tests that occur during complicated pregnancy. This article reviews the forms of pre-existing liver disease that may affect or be affected by pregnancy, as well as liver diseases that tend to arise during pregnancy. Among the pre-existing liver diseases are autoimmune chronic active hepatitis, which may be activated by pregnancy and tends to be associated with an increased risk of still and premature births. Worsening of chronic hepatitis B and C has occasionally been observed. While some women with cirrhosis can sustain a normal pregnancy without any worsening of hepatic function, others develop liver failure; plus, women with cirrhosis are less fertile and have higher rates of both stillbirths and premature infants. Other liver disorders that may or may not be affected by pregnancy include Dubin-Johnson syndrome, Gilbert syndrome, benign recurrent intrahepatic cholestasis, Wilson's disease, hepatic adenomas, and focal nodular hyperplasia. Among the hepatic disorders that occur during pregnancy in normally healthy women and then resolve after delivery is intrahepatic cholestasis of pregnancy (also known as pruritus gravidarum, recurrent intrahepatic cholestasis of pregnancy, and obstetric hepatosis). Others include acute fatty liver of pregnancy and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count), which may be part of the spectrum of disorders associated with pre-eclampsia/eclampsia. Pregnancy may also trigger the dissemination of herpes infection to the liver.


In a pregnant woman without pre-existing liver disease, the first step in managing liver function changes is to distinguish between what is and is not normal. When a woman with liver disease becomes pregnant, however, or when a woman develops any of the rare liver problems specific to pregnancy, a unique set of diagnostic and treatment challenges may ensue. Monitoring the pregnant woman with pre-existing liver disease and recognizing the emergence of liver disease induced by pregnancy are vital to the survival of both mother and child.


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