COMMENTARY

Liver Disease in Pregnancy

Rowen K. Zetterman, MD

Disclosures

April 08, 2013

In This Article

The Liver in Pregnancy

Liver disease that becomes evident during pregnancy can be related to pregnancy, occur independently of pregnancy, or be a consequence of preexisting liver disease. Most liver disease in pregnancy occurs in the late second trimester or third trimester and occasionally in the immediate postpartum interval.

During pregnancy, intravascular volume increases by 40%-50%, peaking at the sixth month of pregnancy, and accompanied by increased heart rate and cardiac output and by reduced systemic vascular resistance. Liver blood flow remains normal and liver size does not change. Because of increased blood volume, blood hematocrit, urea nitrogen, albumin, and total protein levels will decrease.[1] Spider angiomata and palmar erythema related to increased estrogen levels are common during pregnancy,[2] with any number of spiders developing over the upper body in a distribution typical of chronic liver disease. Spider angiomata resolve when pregnancy is over. Aminotransferase, gamma glutamyl transpeptidase, and bilirubin levels remain normal during pregnancy or are 20% lower than average, whereas alkaline phosphatase levels increase up to 3 times normal from placental production.[3] Cholesterol and triglyceride levels also increase during pregnancy, returning to normal following delivery.[4]

Approximately 3% of pregnant women will develop abnormal liver function tests.[5] These patients should be immediately evaluated with a thoughtful history and physical examination, including assessment of new medications, toxin exposure, and gestational duration. In addition, laboratory tests including routine liver tests, complete blood count, platelet count, urinalysis, coagulation studies, and blood urea nitrogen and uric acid levels should be obtained. Ultrasonography of the liver is the safest modality for imaging the maternal liver, although MRI without contrast can also be used.[6]

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