Liver dysfunction during pregnancy has serious consequences.
However, its frequency and characteristics have not been systematically documented in Britain.
In this study, published in the latest issue of Gut, a research team prospectively determined incidence, causes, and outcome of liver dysfunction in pregnancy in an obstetric unit in Wales.
|142 abnormal liver tests had 206 contributing diagnoses, with the great majority being pregnancy specific.|
Abnormal liver tests (bilirubin >25 µmol/l, aspartate transaminase >40 U/l, or glutamyl transpeptidase >35 U/l) from patients in an obstetric unit serving a population of 250 000, were identified by a central laboratory.
The team assessed and followed through all patients with abnormal liver tests during pregnancy.
The research team found that of the 4377 deliveries during the 15 month study, a total of 142 patients had abnormal liver tests.
They identified 206 contributing diagnoses, with the great majority being pregnancy specific.
These included pre-eclampsia (68), HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome (30), obstetric cholestasis (23), hyperemesis gravidarum (11), acute fatty liver of pregnancy (5), and hepatic infarct (1).
In addition, sepsis, postoperative factors, and placental pathology (51) were not uncommonly responsible, however incidental or pre-existing hepatobiliary disease was infrequent (17).
Of the 142 patients, 65 patients were delivered early by induction or cesarean section due of liver dysfunction.
The researchers found that despite substantial liver related morbidity, there were no maternal deaths and only 2 intrauterine deaths.
Dr Ch'ng's team concluded, "Liver dysfunction was seen in 3% of deliveries during a 15 month prospective study and was usually directly related to pregnancy with spontaneous recovery in the puerperium".
"Incidence of the most serious conditions, acute fatty liver of pregnancy and HELLP syndrome, was much greater than previously reported".
"Profound effects on maternal and infant health were observed but close medical and obstetric collaboration ensured low mortality".