Consultation for liver disease during pregnancy remains challenging for both the hepatologist as well as gynecologist, since normal physiologic changes during pregnancy mimic chronic liver disease. Pregnancy-specific liver disorders account for major cases of abnormal liver function tests during pregnancy. Moreover, about 3% of all pregnancies experience liver diseases nonspecific to pregnancy. Severe pregnancy-specific liver disorders may cause significant morbidity and mortality for both the mother and the fetus. 

The type of liver disease; degree of impaired synthetic, metabolic, and excretory liver function; and timing of delivery are the main factors that determine maternal prognosis. 

A systematic approach to diagnosing and managing pregnancy-specific liver disorders includes understanding normal findings in pregnancy, excluding liver diseases nonspecific to pregnancy, factoring in trimester status, and utilizing clinical clues to establish a diagnosis and provide treatment in time.

Following changes may be observed in Liver-Associated Tests during Pregnancy-

Hemoglobin and Albumin may be decreased than pre pregnancy state while alkaline phosphatase and Alpha-fetoprotein may be elevated.

Clinical management of the pregnant patient is challenging due to overlapping findings observed in the pregnant vs nonpregnant patient. Pregnant patient when evaluated for liver disease should first be ruled out for liver disease unrelated to pregnancy such as biliary disease, viral hepatitis, and autoimmune disease. Clinicians must consider trimester status and clinical clues like severe vomiting, nocturnal pruritus, hypertension, proteinuria, and the presence of hemolysis and thrombocytopenia, all of which can help to arrive at the correct diagnosis and deliver suitable care for the mother as well as the child.

Source- Verma D, Saab AM, Saab S, El-Kabany M. A Systematic Approach to Pregnancy-Specific Liver Disorders. Gastroenterol Hepatol (N Y). 2021;17(7):322-329.