Fatty liver and pregnancy: Understanding the risks

• With quotes from Dr. Neelima Thoppa Kapali (gastroenterologist), Dr Chetan Ramesh Kalal (hepatologist)

Acute fatty liver of pregnancy (AFLP) is a severe complication that typically occurs in the third trimester of pregnancy. While it is rare, experts list this condition as one of the most serious pregnancy-related health emergencies.

Dr Chetan Ramesh Kalal, DM hepatologist and program director, adult hepatology and transplant medicine center for liver, pancreas, and intestine transplantation, Nanavati Max Super Specialty Hospital, Mumbai, explains that AFLP is the sudden deposition of fat within liver cells, leading to liver dysfunction and ultimately liver failure. The condition, also known as acute yellow atrophy of the liver, can be life-threatening to both the mother and the fetus.

What causes AFLP?

Professor Dr Neelima Thoppa Kapali, HOD, gastroenterology and liver transplant surgeon, Fortis Malar, Chennai, says that the condition is caused by complications in the metabolism of fatty acids during pregnancy, and can be difficult to predict. The exact nature of the cause of AFLP is yet to be ascertained. However, some of the recent research indicates that it could be due to mitochondrial dysfunction during the breakdown of fatty acids. Dr Kalal points out that one of the enzymes vital for fatty acid breakdown would be missing, leading to excess fat deposition. He also adds that hormonal balance during pregnancy could also have a role in the manifestation of this condition.

“Hormones like estrogen and progesterone undergo substantial fluctuations, which can affect various metabolic processes, including fat metabolism. They can lead to the fat deposition and sudden worsening of liver function,” Dr Kalal adds.

The normal fat content in the liver should be around five percent. However, in women with AFLP, it goes up to as high as 13 to 19 percent. This excess fat deposit, along with ammonia produced by hepatocytes (liver cells involved in lipid breakdown), are the main factors that lead to liver failure.

Precautions

Dr Kapali explains that pregnancy itself causes major changes in a woman’s body. Hence, it is vital to cut alcohol consumption, keep weight in control, and have a well-balanced diet with healthy food. The person should be safer and monitor themselves during pregnancy and keep the liver healthy to avoid acute liver problems.

Dr Kalal also points out that the most important measure is regular prenatal care. Regular checkup allows the doctor to monitor the health of both the mother and fetus. Further, avoiding recreational drugs and substance abuse is crucial. Adequate rest, stress management, prompt medical attention and early detection can also make a significant difference.

Does AFLP affect the fetus or baby?

“Depending on the month of the third trimester in which it occurs, AFLP can have varying impacts on the baby,” informs Dr Kapali. Premature delivery caused by earlier occurrences, such as in the seventh month, can result in severe underdevelopment of the newborn child.

In addition, Dr Kalal highlights that the fetus should be typically observed for hypoglycemia (low sugar). “Due to a defect in fatty acid metabolism, the fetus is predisposed to low sugar and seizures,” he says. So, we need to be very vigilant and monitor them.

Treatment for acute fatty liver of pregnancy

Early detection and prompt medical intervention are crucial in ADLP. Dr Kalal explains that once the person is diagnosed, there should be continuous monitoring of both the mother and the fetus.

The only treatment is urgent childbirth. “AFLP resolves after childbirth, and the mother’s health returns to normal,” explains Dr Kapali. He adds that delivery is crucial because liver dysfunction can lead to respiratory and kidney problems, which can be fatal for both the mother and baby.

“Most of the cases can be handled with adequate medical care, early diagnosis, and prompt delivery,” shares Dr Kalal. But he adds that in some cases if acute fatty liver of pregnancy is diagnosed too late and liver failure occurs, the pregnant woman might require a liver transplant.

Takeaways

• Acute fatty liver of pregnancy is a rare but severe condition. It is usually seen in the third trimester.
• Jaundice is a common symptom of the condition. Once diagnosed, both the mother and the fetus should be continuously monitored.
• It could be fatal to the mother and the baby, and immediate childbirth is the only treatment.
• It is important to maintain a healthy lifestyle, especially during pregnancy, and keep the liver healthy to avoid complications.