Fatty liver of pregnancy is a serious complication that can be potentially life-threatening to both mother and baby. What causes fat to be stored in the liver cells of pregnant women is currently unclear. Treatment consists of terminating the pregnancy promptly. In most cases, the liver regenerates completely in the weeks after birth.
What is fatty liver of pregnancy?
Fatty liver of pregnancy is a rare complication that results in severe liver dysfunction in the expectant mother. Excessive storage of fat in the cells of the liver (hepatocytes) occurs, limiting the liver’s ability to perform its many tasks. Typically, symptoms do not become manifest until the last trimester and can be life-threatening. Fatty liver of pregnancy is generally reversible; all symptoms resolve after delivery. The incidence of this pregnancy complication is estimated to be between 1:7000 and 1:16000, but exact numbers are not available due to the rarity of this hepatologic condition. Diagnosis is a major challenge for the treating physicians. Physicians from different specialties such as hepatology, neonatology, surgery, and gynecology must work together to rule out possible other conditions.
Causes
The exact causes for the development of fatty liver of pregnancy are currently unclear. It is possible that a genetic predisposition plays a role in its development. In some families, this complication occurs in clusters, suggesting the involvement of hereditary factors. In addition, the use of certain medications such as antiepileptic drugs can increase the risk of the disease. In exceptional cases, the disease has been linked to the use of antibiotics during pregnancy. In this hepatologic disease, the breakdown of fatty acids, known as beta-oxidation, is impaired in the cells of the liver. Fatty acids cannot be properly broken down and metabolized, which is why there is an accumulation of fat in the hepatocytes. If this process is not stopped, more and more fat accumulates in the liver until liver failure occurs. The exact pathogenesis is unknown. In rare cases, an enzyme defect in the fetus plays a role in the development of gestational fatty liver.
Symptoms, complaints, and signs
Acute fatty liver of pregnancy occurs largely around the 35th week of pregnancy and is accompanied by many nonspecific symptoms. Affected women often suffer from pain in the upper abdomen, loss of appetite, fatigue, headache, nausea, and vomiting. Persistent back pain may also occur. Usually, the symptoms begin mildly and increase in intensity over time. In an advanced stage, jaundice occurs, with the skin, especially the conjunctiva of the eyes, turning yellow. Affected women usually have a very fast heartbeat. The liver is responsible for producing the blood‘s clotting factors. Therefore, if liver function is impaired, problems with blood clotting may occur. Affected women exhibit pinpoint hemorrhages in the skin. Mucous membranes are frequently affected by these small hemorrhages. There is an increased tendency to bleed during childbirth. In severe courses, gestational fatty liver leads to bleeding into the digestive tract, renal insufficiency, and hepatic encephalopathy with coma. This can lead to death of the expectant mother and the unborn child. Such severe courses are rare because the pregnancy is usually terminated before the pregnant woman’s condition worsens.
Diagnosis and course of the disease
Because of the nonspecific symptoms, the diagnosis of fatty liver of pregnancy is complex and time-consuming. If pregnancy is advanced and symptoms of liver dysfunction are present, a blood test is done first. An ultrasound examination is not always conclusive. If there is no clotting disorder, the diagnosis can be made by biopsy of the liver followed by histologic examination. Fatty liver of pregnancy is a serious disease that, if left untreated, can lead to the death of both the mother and the baby. However, with prompt therapy, the prognosis is considered positive. Just as rare as fatty liver of pregnancy itself are the associated complications.However, if they do occur, they can have serious consequences.
Complications
Possible sequelae of fatty liver of pregnancy do not appear until the last stage of pregnancy. On average, this is around the 35th week of pregnancy. In this case, the affected women often initially suffer from loss of appetite, fatigue, nausea, vomiting, headaches, back pain, as well as painful discomfort in the upper abdomen. Other effects include a yellowish discoloration of the skin and conjunctiva, and an accelerated heartbeat. If the course of gestational fatty liver is intense, complications such as renal insufficiency (kidney weakness) and bleeding within the gastrointestinal region are imminent. In extreme cases, the pregnant woman may slip into a coma. Because liver and blood clotting functions are also affected by fatty liver during pregnancy, blood clotting disorders sometimes occur. They are noticeable in the form of small pinpoint hemorrhages on the skin and mucous membranes. Larger hemorrhages are possible during the birth process. Furthermore, extensive hematomas can form on the liver. Due to the associated increase in pressure, there is a risk of liver rupture. The effects of acute fatty liver of pregnancy also include serious metabolic disturbances such as a lower concentration of sodium and potassium in the blood, hypoglycemia or the breakdown of protein. In some cases, acute pancreatitis also develops. In the worst cases, these severe complications even result in the death of the pregnant woman or her child.
When should you go to the doctor?
Fatty liver of pregnancy must always be treated immediately by a doctor. It is a serious condition that can lead to serious complications and discomfort if left untreated. The earlier fatty liver of pregnancy is detected and treated, the better the further course. A doctor should be consulted if the affected person suffers from severe pain in the abdomen or a severe loss of appetite. There may also be significant fatigue, as well as nausea or severe headaches. Furthermore, frequent vomiting can also be an indication of fatty liver during pregnancy and should be examined by a doctor if it occurs permanently and does not disappear again on its own. In many cases, there is discomfort of the skin, jaundice or severe pain in the back. A doctor should always be consulted for these complaints as well. In the case of fatty liver of pregnancy, a gynecologist or a general practitioner is usually consulted. Further treatment then takes place in a hospital. In most cases, if diagnosed early, the disease can be treated relatively well, so that the life expectancy of the mother and the child are not affected.
Treatment and therapy
The only causative therapy for fatty liver of pregnancy is induction of labor. Depending on the situation and the health condition of the pregnant woman, labor may be induced with medication or a cesarean section may be performed. The delivery of the baby is usually done as soon as possible to prevent acute liver failure in the pregnant woman. Since this is a serious complication, affected women are mainly treated in the intensive care unit. This is necessary, among other reasons, because the health condition can deteriorate very quickly and requires immediate action. A blood transfusion may be necessary. Administration of clotting factors is important, especially in advanced fatty liver, to counteract the tendency to bleed. After delivery, the newborn is examined for enzyme defects and further treatment is initiated if necessary. If delivery was initiated early enough, most of the disease regresses rapidly and the pregnant woman can leave the hospital a few weeks after delivery. In severe cases, there may be no improvement in liver function postpartum. If acute liver failure is present, only liver transplantation can save the woman’s life. Affected women must be educated about the risk of recurrence of the disease in another pregnancy after recovery.
Prevention
Currently, it is not known exactly what leads to the development of gestational fatty liver. Accordingly, specific prevention is not possible.If there are known cases of hepatological complications during pregnancy in the family, this should be discussed with the treating gynecologist during a screening examination. Close monitoring examinations may then be necessary in the last third of the pregnancy. In addition, the use of medication during pregnancy should always be discussed with a specialist in gynecology. In general, the condition is so rare that there is no cause for concern for most pregnant women.
Follow-up care
Because gestational fatty liver is a condition that occurs temporarily in association with pregnancy, it is entirely possible that it will resolve on its own after delivery. The body can return to normal metabolism. Follow-up care varies greatly depending on the course of the condition. Control examinations are required, as well as regular blood sampling with determination of liver values. This provides a very good indication of the course and healing. Sonographic examination can also provide indications of healing. However, it is to be expected that even after pregnancy the body will need some time to regulate the processes and break down the fat stored in the liver. In difficult cases, a consistent change in lifestyle habits may be necessary. This refers in particular to the diet and the increase in sports activities. Even after the fatty liver of pregnancy has healed, a healthy lifestyle should be continued. For this purpose, the attending physician can provide appropriate tips and help during the follow-up examinations. Complicated courses with strong weight gain and persistent fatty liver disease should always be observed and co-treated by an experienced gastroenterologist, as recurrence of symptoms may occur.
Here’s what you can do yourself
This condition, which is life-threatening to women and their still-unborn baby, rarely occurs. However, it does force doctors to act: The child must be carried to term as soon as possible to avoid severe courses with momentous complications. Affected mothers are therefore well advised to agree to an early induction of labor. All the symptoms associated with fatty liver during pregnancy disappear in the vast majority of cases after the child is delivered, i.e. they are reversible. Nevertheless, it is advisable to continue to pay attention to one’s own liver health even after the hospital stay. The liver is a detoxification organ. To avoid putting unnecessary strain on it, as few toxins as possible should be taken in. Alcohol, nicotine, fatty and sweet foods are taboo, as is indiscriminate use of medications. Even over-the-counter remedies can put a strain on the liver. Naturopaths recommend drinking plenty of green tea for liver detoxification because it is said to dissolve fat in the liver and be able to eliminate it. Artichokes are also considered a liver protector. Detoxification measures also relieve the liver. Anything that makes you sweat is recommended, such as sauna sessions, steam baths or even sports. Food also has a detoxifying effect. Curcuma, a curry spice, is said to boost detoxification. But asparagus and water-rich fruits also help flush out unnecessary toxins in the body.