Liver Disease and Pregnancy

Introduction: Pregnancy is a normal physiological process and one of the most joyful and anticipated stages of life. However, some pregnancies can be more complicated with the development of medical problems such as gestational diabetes, pre-eclampsia or cholestasis. Additionally pregnancy may exacerbate pre-existing medical conditions. This article aims to briefly review issues in pregnancy relating to liver disease. We will start by reviewing the normal liver changes in pregnancy, pre-existing liver disease, and liver disease occurring only in pregnancy and finally highlight of the role of the multidisciplinary team and other relevant factors.

During pregnancy, the liver undergoes physiological and anatomical changes Physical examination findings include telangiectasias, spider angiomas and palmar erythema can be seen during the late half of the pregnancy because of the elevated levels of oestrogen. serum alkaline phosphatase (ALP) increases up to four times in the third trimester as a result of the elevated levels of placental alkaline phosphatase. Other liver biochemical tests such as serum alanine transferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT) and total and free bilirubin typically remain within normal limits so any abnormal value should warrant further evaluation. As there is haemodilution, it is normal to have a mild decrease in serum albumin. Total cholesterol, triglyceride, fibrinogen and ceruloplasmin are augmented during pregnancy while prothrombin time (PT) and activated partial thromboplastin time (APTT) remain stable. Ultrasonography examination in pregnancy normally shows a normal biliary tree, increased fasting gallbladder volume and residual volume post contraction.