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Liver and Gallbladder Disorders During Pregnancy

by Lara A. Friel, MD, PhD

Some liver disorders occur only during pregnancy. Others (such as gallstones, cirrhosis, or hepatitis) may have been present before the pregnancy, or they may occur coincidentally with the pregnancy.

Liver or gallbladder problems may result from hormonal changes during pregnancy. Some changes cause only minor, transient symptoms.

Cholestasis of pregnancy

The normal hormonal effects of pregnancy can slow the movement of bile through the bile ducts. This slowing is called cholestasis. The most obvious symptom is itching all over the body (usually in the last few months of pregnancy). No rash develops. Urine may be dark, and jaundice may develop.

If itching is intense, a drug called ursodeoxycholic acid, taken by mouth, may be prescribed.

The disorder usually resolves after delivery but tends to recur in subsequent pregnancies or with use of oral contraceptives.

Fatty liver of pregnancy

This rare disorder can develop toward the end of pregnancy. The cause is unknown. Symptoms include nausea, vomiting, abdominal discomfort, and jaundice. The disorder may rapidly worsen, and liver failure may develop.

Diagnosis is based on results of liver function tests and may be confirmed by a liver biopsy. The doctor may advise women to immediately end the pregnancy. The risk of death for pregnant women and the fetus is high in severe cases, but those who survive recover completely. Usually, the disorder does not recur in subsequent pregnancies.

Gallstones

Gallstones appear to be more common during pregnancy. Pregnant women who develop gallstones are closely monitored. If a gallstone blocks the gallbladder or causes an infection, surgery may be necessary. This surgery is usually safe for pregnant women and the fetus.

Cirrhosis

Cirrhosis (scarring of the liver) increases the risk of miscarrying or giving birth prematurely. Cirrhosis can cause varicose veins (widened, convoluted veins) to develop around the esophagus (called esophageal varices). Pregnancy slightly increases the risk that these veins will bleed profusely, especially during the last 3 months of pregnancy.

Hepatitis

Acute viral hepatitis (see Acute Viral Hepatitis) may increase the risk of premature birth. It is also the most common cause of jaundice during pregnancy. Hepatitis B may be transmitted to the baby immediately after delivery or, less often, during the pregnancy. Most infected babies have no symptoms and have only mild liver dysfunction. But they are carriers of the infection and may transmit it to others. All pregnant women are tested for hepatitis, and if they are infected, measures are taken to prevent the baby from being infected.

Women with chronic hepatitis, especially if cirrhosis is present, may have difficulty becoming pregnant. If they become pregnant, they are more likely to miscarry or to give birth prematurely. If women were taking corticosteroids before the pregnancy, they can continue to take them during pregnancy.