Fatty liver in pregnancy: a narrative review of two distinct conditions

ABSTRACT

Introduction: Fatty liver is rather common in pregnancy, occurring in two totally different conditions, i.e. nonalcoholic fatty liver disease (NAFLD) in pregnancy and acute fatty liver of pregnancy (AFLP). The former is a common condition, resulting by chance association because of the epidemics of obesity and the older age of many pregnant women in Western countries; the latter is a rare disease whose pathophysiology is still incompletely understood.

Areas covered: We reviewed the evidence-based knowledge on fatty liver in/of pregnancy. For NAFLD, a few large retrospective and prospective studies identify immediate and late risks for both the mother and the fetus. For AFLP, only small retrospective studies are available, indicating that prompt delivery and eventual referral to Liver Units for liver support or transplantation are mandatory to avoid maternal and fetal death.

Expert opinion: The number of pregnant women with fatty liver is expected to increase in the next years. Pharmacologic treatment of NAFLD might be postponed, even when new drugs are approved by health authorities for the general population. In the case of AFLP, we need to improve our ability to correctly identify and treat the most severe cases not resolving with delivery.

KEYWORDS:

• Acute fatty liver
• fibrosis
• gestational diabetes
• hellp syndrome
• liver enzymes
• metabolic syndrome
• nonalcoholic fatty liver disease
• pregnancy
• ultrasonography

Article Highlights

• The prevalence of fatty liver is high in pregnant women. In most cases, it occurs by chance, as part of metabolic liver disease, fueled by the epidemics of obesity and the older age of pregnant women; in rare cases, it presents as acute fatty liver of pregnancy

• The common form (nonalcoholic fatty liver) is exclusively managed by careful dietary intervention; pharmacologic intervention is limited to appropriate antidiabetic drugs in the event that it is accompanied by gestational diabetes

• Acute fatty liver of pregnancy is a clinical emergency that requires prompt delivery and immediate referral to liver units, considering the high risk of acute liver failure.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.