liver in pregnancy

Overview

The liver is your body's filter and energy store. It helps clear waste and makes bile to digest food. During pregnancy, hormone changes can affect how the liver works. Some people develop liver problems during pregnancy, and these need medical care to keep both mother and baby safe.

Mild changes in liver blood tests are fairly common in pregnancy, affecting up to 5 in 100 pregnant persons. But serious liver disease is rare.

It can affect any pregnant person. Some conditions, like intrahepatic cholestasis of pregnancy, often start in the third trimester and are more common in certain families.

Symptoms

Common symptoms

• Itchy skin, especially on the palms and soles
• Yellowing of the skin or whites of the eyes (jaundice)
• Dark urine or pale bowel motions
• Nausea and vomiting
• Pain in the upper right side of the belly
• Feeling very tired
• Swelling in the hands, feet, or face

Symptoms in children

• This condition affects the pregnant person, not children. However, the unborn baby may be affected, so the baby's heart rate and growth will be checked regularly.

Symptoms in older adults

• Pregnancy-related liver problems only happen during pregnancy, so they do not affect older adults.

Causes

Main causes

• Hormonal changes in pregnancy can slow the flow of bile from the liver, leading to a build-up of bile acids.
• Some pregnancy conditions, like pre-eclampsia, affect blood vessels and can damage the liver.
• Acute fatty liver of pregnancy is a rare condition where fat collects in liver cells, but the exact cause is not fully understood.
• The liver may already be weaker because of a previous liver disease, and pregnancy adds extra stress.

Risk factors

• Previous pregnancy with a liver problem
• Family history of intrahepatic cholestasis of pregnancy
• Carrying twins or more
• Existing liver disease, such as hepatitis
• History of pre-eclampsia
• Pregnancy after fertility treatment

When to see a doctor

See a doctor urgently if:

• If you have any emergency symptoms, call your local emergency number immediately. Also call your doctor or midwife the same day if you have jaundice, severe itching, or feel very unwell.

Book a routine appointment if:

• Mention any new symptoms at your regular prenatal appointments, especially any itching, tiredness, or swelling. Your provider can order simple blood tests to check your liver.

Diagnosis

Your doctor or midwife will ask about your symptoms and may examine your belly. You will likely have blood tests to check how well your liver is working. Sometimes an ultrasound of your liver is done. Your blood pressure and urine will also be checked.

Tests that may be done

• Blood tests for liver enzymes and bilirubin
• Blood tests for bile acids
• Full blood count to check red cells, white cells, and platelets
• Blood pressure measurement
• Urine test to check for protein
• Ultrasound scan of your liver
• Fetal monitoring: ultrasound to check the baby's growth and heart rate

What to expect at your appointment

You may be referred to a specialist obstetrician or a liver doctor (hepatologist). The tests are safe and painless. You will likely be monitored with more frequent visits. In some cases, you may be admitted to hospital for closer observation.

Treatment

Treatment depends on the specific liver condition and how severe it is. The main goals are to reduce symptoms, protect the liver, and make sure your baby is growing well. Sometimes the safest step is to deliver the baby early.

Self-care at home

• Rest often and stay hydrated.
• Eat small, frequent meals if you feel sick.
• Avoid alcohol and any medicines or supplements not approved by your doctor.
• Take lukewarm baths or use unscented moisturizer to soothe itching.
• Keep a diary of your symptoms to share with your care team.
• Do gentle activities only if you feel up to it.

Medical treatments

Your doctor may prescribe medicines to lower bile acids, control blood pressure, or reduce stomach acid. If there is a risk of early delivery, you may receive treatment to help your baby's lungs mature. Always take medicines exactly as prescribed by your healthcare team. Do not start or stop anything without talking to them.

When is surgery considered?

Surgery is rarely needed. In an emergency, such as severe bleeding, a caesarean section may be performed. Most liver problems in pregnancy are managed without any operation.

Living with this condition

You will probably have more prenatal check-ups than usual. This is to keep you and your baby safe. Try to rest when you can and ask for help at home. After birth, most liver changes return to normal within a few weeks. You may need follow-up blood tests to make sure your liver has recovered.

Lifestyle tips

• Go to all your scheduled prenatal appointments.
• Get enough sleep and rest.
• Ask your provider before taking any over-the-counter medicines, including herbal products.
• Avoid alcohol completely.
• Tell your care team about any new or worsening symptoms.
• Make a plan with your provider for monitoring after birth.

Diet and exercise

Eat a balanced diet with plenty of vegetables, fruits, whole grains, and lean protein. If you have nausea, small frequent meals may help. Drink enough water. Light walking is usually fine, but check with your provider first. Avoid strenuous exercise if you don't feel well.

Mental health and emotional wellbeing

Being diagnosed with a health problem during pregnancy can be scary and stressful. It's normal to feel anxious or worried. Talk to someone you trust, and consider speaking to a counselor. Your healthcare team cares about your mental health too — let them know how you're feeling.

Prevention

Most pregnancy-related liver problems can't be prevented. But attending prenatal appointments and reporting symptoms early can help catch problems before they become serious. If you have a known liver condition, talk to your doctor before getting pregnant.

Vaccines

Before pregnancy, make sure your hepatitis A and B vaccinations are up to date. During pregnancy, some vaccines can be given, but discuss any vaccine with your doctor first.

Screening programmes

Prenatal blood tests screen for some liver issues. If you have risk factors, your doctor may recommend more frequent blood pressure checks and liver tests.

Complications

If left untreated

• Liver failure, where the liver stops working properly
• Severe bleeding (hemorrhage) after birth
• Premature birth
• The baby may not get enough oxygen or nutrition
• In very rare cases, stillbirth

Long-term outlook

With early detection and proper care, most women with pregnancy-related liver conditions recover fully. The outlook is good for both mother and baby. After delivery, your liver usually returns to normal, though you may need follow-up checks. You and your baby will be monitored to ensure the best possible outcome.

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