Acute Fatty Liver of Pregnancy

What is acute fatty liver of pregnancy?

Acute fatty liver of pregnancy (AFLP) is a rare, but serious, condition that can cause liver failure, as well as other life-threatening complications. It happens when too much fat builds up in your liver when you’re pregnant. It’s a medical emergency and involves delivering the fetus as soon as possible.

How common is acute fatty liver of pregnancy?

AFLP is rare. It affects about 1 in 10,000 to 20,000 pregnancies each year.

What are the symptoms of acute fatty liver of pregnancy?

AFLP typically starts late in the third trimester of pregnancy — 36 weeks is the average length of the pregnancy at diagnosis. However, it can occur up until delivery or sooner.

The most common symptoms of AFLP include:

• Nausea and vomiting.
• Abdominal pain (mainly on the upper right side).
• Tiredness.
• A general unwell feeling.
• Loss of appetite.
• Excessive thirst.
• Jaundice (yellowing of your skin and whites of your eyes).
• Confusion or being unable to concentrate.

The symptoms of AFLP resemble symptoms of other conditions. Discuss any symptoms you’re having during pregnancy with your pregnancy care provider. AFLP is a medical emergency and requires prompt treatment.

What is the cause of acute fatty liver of pregnancy?

Researchers aren’t sure what causes acute fatty liver of pregnancy. Your liver is responsible for breaking down fatty acids. With AFLP, there’s too much fat in your liver due to a problem with how your liver breaks down fat. The fat clogs up your liver and interferes with how it functions. This can be deadly if left untreated.

Studies show AFLP may be genetic. An enzyme deficiency called long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) may cause AFLP.

LCHAD deficiency is a rare autosomal recessive disorder. This means both biological parents must have the gene to pass it to the fetus. With LCHAD, the fetus can’t metabolize fatty acids. The fatty acids pass through the placenta to the pregnant person’s bloodstream. This, in turn, can cause fat to build up in your liver.

What are the risk factors for acute fatty liver of pregnancy?

AFLP may be genetic, meaning you inherit it from your biological parents. Other risk factors may be that:

• It’s your first pregnancy.
• You’re having twins or more.
• You’re expecting a male fetus.
• You have diabetes.
• You have intrahepatic cholestasis of pregnancy.
• You have preeclampsia.
• You have obesity.

Your pregnancy care provider can’t predict if you’ll get acute fatty liver of pregnancy, even if you have all of the risk factors. Along with being unpredictable, it’s also unpreventable.

What are the complications of acute fatty liver of pregnancy?

Acute fatty liver of pregnancy can be deadly. Both you and the fetus are at risk for many complications. Some of these are:

• Liver failure.
• Kidney failure.
• Lung failure.
• Infection.
• Hemorrhage.

How is acute fatty liver of pregnancy diagnosed?

Early diagnosis and quick treatment is essential as AFLP can lead to organ failure. The most accurate diagnostic tool is a liver biopsy, which involves your healthcare provider examining your liver tissue under a microscope. However, this isn’t always safe in pregnancy. Often, your pregnancy care provider can diagnose AFLP based on your symptoms and health history.

Your provider will order blood tests to look for AFLP. Results of your liver function blood test may raise a red flag and lead your provider to suspect AFLP. These tests often show signs of:

• Higher levels of liver enzymes (elevated liver enzymes).
• Problems with how your blood clots.
• Increases of ammonia, uric acid and protein in your blood.
• Low blood sugar values.
• Evidence of kidney damage.

To make a diagnosis, your provider may also order an ultrasound or computed tomography (CT scan) to get a detailed view of your liver.

How is acute fatty liver of pregnancy treated?

Your pregnancy care provider will recommend delivery as soon as possible to avoid life-threatening complications. Your liver can begin healing itself once your provider removes the fetus and the placenta.

What can I do to lower my risk of acute fatty liver of pregnancy?

AFLP is rare, and there isn’t anything you can do to prevent it or predict it.

What can I expect if I have acute fatty liver of pregnancy?

AFLP requires immediate delivery. Your liver function typically returns to normal within 10 days of delivery. You may need to remain in the hospital under your provider’s care until your liver test values are in a typical range.

Your risk of getting AFLP again is unknown. Your provider may recommend genetic testing to see if any fatty acid abnormalities contributed to developing AFLP. They may also recommend a maternal-fetal medicine specialist monitor any future pregnancies.

What happens to the fetus?

In general, the more severe the disease is, the more effects it has on the fetus. Some children are at risk for developing nonketotic hypoglycemia, a condition that prevents them from processing amino acids. Others may have dilated cardiomyopathy or neuropathy. The risk to the fetus is usually less than the risk to the pregnant person.

When should I see my healthcare provider?

It’s important to share your complete medical history with your pregnancy care provider and let them know of any symptoms you have during pregnancy. Being transparent and honest with them is the best way to get the care you need during pregnancy.

Contact your healthcare provider if you feel any of the following symptoms during pregnancy:

• Abdominal pain or pelvic pain that doesn’t go away.
• Extreme tiredness or feeling unwell.
• Nausea and vomiting.
• Headaches that don’t go away.

What questions should I ask my provider?

If your provider diagnoses you with AFLP, it’s normal to have lots of questions. You may want to ask:

• Do I need to deliver right now?
• Is my life at risk? Is my baby’s life at risk?
• Will AFLP go away?
• What treatments do I need?
• Will this happen if I get pregnant again?
• Do you know why this happened?

How is acute fatty liver of pregnancy different from HELLP syndrome?

Hemolysis, Elevated Liver enzymes, and Low Platelet count syndrome (HELLP) is a condition during pregnancy that has similarities to AFLP. The main difference between the two conditions is seen in changes in blood work results over time. AFLP typically causes clotting issues as well as changes in platelet levels. HELLP syndrome typically causes a more progressive decline in platelet count. Additionally, people with AFLP are more likely to have:

• Severe abnormalities in liver function tests.
• Some evidence of abnormal blood glucose.
• Signs of abnormal kidney function.
• High bilirubin in lab tests. Bilirubin is a waste product.
• Acidosis (a buildup of acid in your blood).
• Proteinuria.
• Changes to brain function like the inability to think clearly or becoming confused.

Is it normal to have fatty liver in pregnancy?

Fatty liver disease is a common, treatable condition in people who aren’t pregnant. Most people have some fat in their liver. However, fatty liver can progress to liver failure. During pregnancy, it’s especially dangerous because your liver removes toxins from your body. If your liver (or the fetus’s liver) isn’t functioning properly, harmful substances can clog your bloodstream.

A note from Cleveland Clinic

AFLP is a rare, serious condition that affects your liver during pregnancy. It’s unpreventable and unpredictable. This means it’s important to talk to your pregnancy care provider about your health history as well as any symptoms you have during pregnancy. These discussions can help your provider detect potential complications and get you the care you need.