Implications of abnormal liver function in pregnancy and non-alcoholic fatty liver disease

• Published in: Best practice & research. Clinical obstetrics & gynaecology 2020-10, Vol.68, p.2-11
• Main Author: Lao, Terence T.
• Format: Article
• Language: English
• Subjects: Gestational diabetes mellitus; Liver function test in pregnancy; Non-alcoholic fatty liver disease; Polycystic ovarian syndrome; Pre-eclampsia; Preterm birth
• ISSN: 1521-6934; 1532-1932
• DOI: 10.1016/j.bpobgyn.2020.02.011

Elevated liver enzyme levels can sometimes be encountered in asymptomatic pregnant women. Similar to non-pregnant subjects, women with elevated gamma glutamyltransferase or alanine aminotransferase in early pregnancy have increased risk of subsequent complications, especially gestational diabetes mellitus. In non-pregnant subjects, the commonest cause of abnormal liver function currently is non-alcoholic fatty liver disease. Risk factors include obesity, diabetes, and the metabolic syndrome. It can progress to hepatocellular carcinoma through the development of steatohepatitis, and has become the leading cause for liver transplantation in women. Found in as many as 16–18% of pregnant women, it is associated with an increased risk of pregnancy complications and abnormal foetal growth, which predisposes the offspring to the same problem subsequently. This condition probably explains the majority of the cases of “idiopathic” abnormal liver function in pregnancy, and should be looked out for in high-risk women owing to its implications on their long-term health outcome. •Asymptomatic elevation of liver enzymes increases the risk of obstetric complications.•Causes of elevated liver enzymes in pregnancy can include infections and NAFLD.•NAFLD is estimated in 10% women aged 20–40 years and in 16–18% of pregnant women.•NAFLD increases the risk of pregnancy complications and foetal growth abnormality.•Postpartum management is recommended for NAFLD due to long-term health implications.