Liver disease in pregnancy

Abstract Liver disease may pre-date conception, coincidentally occur during the pregnancy or be caused by it. Obstetric cholestasis is a liver disorder unique to pregnancy; it presents with pruritus and commonly has its onset in the third trimester. It is an important diagnosis to consider in a pregnant woman with pruritus as it is associated with premature delivery, fetal distress, meconium staining of liquor and intrauterine death. There is no treatment to reverse the condition, and palliation of symptoms and elective early delivery are the main management options with ursodeoxycholic acid being used in some cases. The condition reverses on delivery but can recur in subsequent pregnancies. Liver disease that may coincidentally occur in pregnancy includes cholelithiasis. An incidental finding of gallstones in pregnant women is common and pregnancy may predispose the formation of gallstones as a result of the altered cholesterol metabolism. Management is similar to that outside pregnancy. Less common disorders with effects on the liver such as inflammatory bowel disease, and congenital defects in bilirubin metabolism may also occur in women of childbearing age, and pregnancy in women with these conditions is thought to be compatible with good obstetric outcomes. Little is known of the effects on pregnancy of rare liver disorders such as sclerosing cholangitis, Budd Chiari syndrome and primary biliary cirrhosis but pregnancies have been reported.