Liver disease in pregnancy

The presence of deranged liver function tests is common in pregnancy, but it can be a challenge to elucidate the cause. The history and clinical assessment provide useful tools for distinguishing between pregnancy-related causes, such as pre-eclampsia, acute fatty liver of pregnancy and obstetric cholestasis, and non-pregnancy-related causes such as acute viral infection, autoimmune liver disease and Budd–Chiari syndrome. Pregnancy can also affect the natural course of liver conditions, for example by increasing the risk of bleeding of a hepatic adenoma, a flare in autoimmune hepatitis, or the severity of hepatitis E infection.It is important for clinicians to be aware of the impact of liver disorders and the drugs used to treat them on pregnancy and to understand the influence of pregnancy on the course of specific disorders.