Hepatic dysfunction in a gestational woman can arises from pregnancy-related factors, illnesses that occur concurrently with gestation, or previously existing hepatic disorders which is aggravated by pregnancy. Abnormal liver test findings occur in 3% to 5% of pregnancies due to a variety of probable causes, with clinical effects ranging from self-limiting to swiftly deadly. Abnormal liver tests in pregnant individuals are caused by four major conditions: (i) Physiological changes in pregnancy, (ii) Newly acquired Liver disease, (iii) Pre-existing Liver disease, and (iv) Pregnancy-related Liver disease. Physiologic changes in pregnant women lead to abnormal liver function tests. Hepatic disorders may result in severe illness and death in both mothers as well as fetuses. Quick identification of the disease is crucial, as in critical situations immediate delivery is vital for the mother and developing infant survival. This review focuses on liver problems that are specific to pregnancy. Hyperemesis gravidarum (HG), which appears within the first 12 weeks of pregnancy, is connected to liver damage. Intrahepatic Cholestasis of Pregnancy (ICP) is the most prominent all across the middle and the end term of pregnancy. After birth, pruritus and the related biochemical indications of cholestasis resolve. Both pre-eclampsia and HELLP (elevated liver enzymes, hemolysis, and low platelets) are severe conditions that arise in the last term of pregnancy. Acute fatty liver during pregnancy (AFLP) is a potentially dangerous, uncommon condition that can affect pregnancy’s third trimester. This review summarizes the etiologies, pathogenesis, identification, and treatment of hepatic disorders during pregnancy.
Abildgaard, U., & Heimdal, K. (2013). Pathogenesis of the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP): a review. European Journal of Obstetrics & Gynecology and Reproductive Biology, 166(2), 117-123. https://doi.org/10.1016/j.ejogrb.2012.09.026
Acharya, S. K. (2013). Hepatitis E and acute liver failure in pregnancy. Journal of clinical and experimental hepatology, 3(3), 213-224. https://doi.org/10.1016/j.jceh.2013.08.009
Ahmed, K. T., Almashhrawi, A. A., Rahman, R. N., Hammoud, G. M., & Ibdah, J. A. (2013). Liver diseases in pregnancy: diseases unique to pregnancy. World Journal of Gastroenterology: WJG, 19(43), 7639. https://doi.org/10.3748/wjg.v19.i43.7639
Akinloye, O., Obikoya, O. M., Jegede, A. I., Oparinde, D. P., & Arowojolu, A. O. (2013). Cortisol plays central role in biochemical changes during pregnancy. International Journal of Medicine and Biomedical Research, 2(1), 3-12. https://doi.org/10.14194/ijmbr.212
Asrani, S. K., Devarbhavi, H., Eaton, J., & Kamath, P. S. (2019). Burden of liver diseases in the world. Journal of hepatology, 70(1), 151-171. https://doi.org/10.1016/j.jhep.2018.09.014
Bacq, Y. (2011). Liver diseases unique to pregnancy: a 2010 update. Clinics and research in hepatology and gastroenterology, 35(3), 182-193. https://doi.org/10.1016/j.clinre.2010.11.011
Bleeser, T., Vally, J. C., Van de Velde, M., Rex, S., & Devroe, S. (2022). General anaesthesia for nonobstetric surgery during pregnancy: A narrative review. European Journal of Anaesthesiology and Intensive Care, 1(2), e003. https://doi.org/10.1097/EA9.0000000000000003
Boyer, J. L. (2013). Bile formation and secretion. Comprehensive physiology, 3(3), 1035. https://doi.org/10.1002/cphy.c120027
Chaiworapongsa, T., Chaemsaithong, P., Yeo, L., & Romero, R. (2014). Pre-eclampsia part1: current understanding of its pathophysiology. Nature Reviews Nephrology, 10(8), 466-480. https://doi.org/10.1038/nrneph.2014.102
Ditisheim, A., & Sibai, B. M. (2017). Diagnosis and management of HELLP syndrome complicated by liver hematoma. Clinical obstetrics and gynecology, 60(1), 190-197. https://doi.org/10.1097/GRF.0000000000000253
Dusse, L. M., Alpoim, P. N., Silva, J. T., Rios, D. R. A., Brandão, A. H., & Cabral, A. C. V. (2015). Revisiting HELLP syndrome. Clinica Chimica Acta, 451, 117-120. https://doi.org/10.1016/j.cca.2015.10.024
Ekun, O. A., Ogidi, N. O., Lawal, R. A., Ogunmuyiwa, O. A., Umewune, M. C., Adefolaju, F. O., … & Oremosu, A. I. (2018). Interrelationship between markers of oxidative stress, inflammation and hematological parameters among preeclamptic Nigerian women. Medical Science Monitor Basic Research, 24, 225. https://doi.org/10.12659/MSMBR.910660
English, F. A., Kenny, L. C., & McCarthy, F. P. (2015). Risk factors and effective management of preeclampsia. Integrated blood pressure control, 8, 7. https://doi.org/10.2147/IBPC.S50641
Esposti, S. D., Nee, J., & Saha, S. (2015). The Gastrointestinal Tract and the Liver in Pregnancy: Normal Functions and Diseases. In Medical Management of the Pregnant Patient (pp. 81-130). Springer, New York, NY. https://doi.org/10.1007/978-1-4614-1244-1_5
Folk, D. M. (2018). Hypertensive disorders of pregnancy: overview and current recommendations. Journal of midwifery & women’s health, 63(3), 289-300. https://doi.org/10.1111/jmwh.12725
García-Romero, C. S., Guzman, C., Cervantes, A., & Cerbón, M. (2019). Liver disease in pregnancy: Medical aspects and their implications for mother and child. Annals of hepatology, 18(4), 553-562. https://doi.org/10.1016/j.aohep.2019.04.009
Gauer, R. L., & Braun, M. M. (2012). Thrombocytopenia. American family physician, 85(6), 612-622.
Geenes, V., Chambers, J., Khurana, R., Shemer, E. W., Sia, W., Mandair, D., … & Williamson, C. (2015). Rifampicin in the treatment of severe intrahepatic cholestasis of pregnancy. European Journal of Obstetrics & Gynecology and Reproductive Biology, 189, 5-63. https://doi.org/10.1016/j.ejogrb.2015.03.020
Hammoud, G. M., & Ibdah, J. A. (2014). Preeclampsia‐induced Liver Dysfunction, HELLP syndrome, and acute fatty liver of pregnancy. Clinical Liver Disease, 4(3), 69. https://doi.org/10.1002/cld.409
Henkel, S. A., Squires, J. H., Ayers, M., Ganoza, A., Mckiernan, P., & Squires, J. E. (2019). Expanding etiology of progressive familial intrahepatic cholestasis. World Journal of Hepatology, 11(5), 450. https://doi.org/10.4254/wjh.v11.i5.450
Herrera, E., & Ortega-Senovilla, H. (2014). Lipid metabolism during pregnancy and its implications for fetal growth. Current pharmaceutical biotechnology, 15(1), 24-31.
Huang, L., Li, X., Liu, T., Wei, L., Fan, C., Tang, D., … & Xiong, Z. (2022). Effect of intrahepatic cholestasis of pregnancy on infantile food allergy: A retrospective longitudinal study cohort in Southwest China. European Journal of Obstetrics & Gynaecology and Reproductive Biology, 272, 110-115. https://doi.org/10.1016/j.ejogrb.2022.03.026
Jeyabalan, A. (2013). Epidemiology of preeclampsia: impact of obesity. Nutrition reviews, 71(suppl_1), S18-S25. https://doi.org/10.1111/nure.12055
Joshi, D., James, A., Quaglia, A., Westbrook, R. H., & Heneghan, M. A. (2010). Liver disease in pregnancy. The Lancet, 375(9714), 594-605. https://doi.org/10.1016/S0140-6736(09)61495-1
Kamimura, K., Abe, H., Kawai, H., Kamimura, H., Kobayashi, Y., Nomoto, M., … & Terai, S. (2015). Advances in understanding and treating liver diseases during pregnancy: A review. World Journal of Gastroenterology: WJG, 21(17), 5183. https://doi.org/10.3748/wjg.v21.i17.5183
Kee-Hak, L. Preeclampsia: practice essentials, overview, pathophysiology [cited 2017 Nov 24].
Lanzafame, R. J. (2019). Cholelithiasis, cholecystitis, and cholecystodochotomy during pregnancy. In Non-Obstetric Surgery During Pregnancy (pp. 147-154). Springer, Cham. https://doi.org/10.1007/978-3-319-90752-9_11
Lata, I. (2013). Hepatobiliary diseases during pregnancy and their management: An update. International journal of critical illness and injury science, 3(3), 175. https://doi.org/10.4103/2229-5151.119196
Leventhal, T. M., & Liu, K. D. (2015). What a nephrologist needs to know about acute liver failure. Advances in Chronic Kidney Disease, 22(5), 376-381. https://doi.org/10.1053/j.ackd.2015.06.006
Liu, J., Ghaziani, T. T., & Wolf, J. L. (2017). Acute fatty liver disease of pregnancy: updates in pathogenesis, diagnosis, and management. Official journal of the American College of Gastroenterology| ACG, 112(6), 838-846. https://doi.org/10.1038/ajg.2017.54
Ma, K., Berger, D., & Reau, N. (2019). Liver diseases during pregnancy. Clinics in liver disease, 23(2), 345-361. https://doi.org/10.1016/j.cld.2018.12.013
MacGibbon, K. W. (2020). Hyperemesis gravidarum: strategies to improve outcomes. Journal of Infusion Nursing, 43(2), 78-96. https://doi.org/10.1097/NAN.0000000000000363
Magee, L. A., & von Dadelszen, P. (2018, November). State-of-the-art diagnosis and treatment of hypertension in pregnancy. In Mayo Clinic Proceedings (Vol. 93, No. 11, pp. 1664-1677). Elsevier. https://doi.org/10.1016/j.mayocp.2018.04.033
Mahle, A. C., Morris, B. D., Frazer, Z., & Novak, C. (2021). Severe vitamin deficiencies in pregnancy complicated by progressive familial intrahepatic cholestasis. BMJ Case Reports CP, 14(3), e240248. http://dx.doi.org/10.1136/bcr-2020-240248
Manzotti, C., Casazza, G., Stimac, T., Nikolova, D., & Gluud, C. (2019). Total serum bile acids or serum bile acid profile, or both, for the diagnosis of intrahepatic cholestasis of pregnancy. Cochrane Database of Systematic Reviews, (7). https://doi.org/10.1002/14651858.CD012546.pub2
Martin Jr, J. N., Owens, M. Y., Keiser, S. D., Parrish, M. R., Tam Tam, K. B., Brewer, J. M., … & May, W. L. (2012). Standardized Mississippi Protocol treatment of 190 patients with HELLP syndrome: slowing disease progression and preventing new major maternal morbidity. Hypertension in pregnancy, 31(1), 79-90. https://doi.org/10.3109/10641955.2010.525277
Meng, J., Wang, S., Gu, Y., Lv, H., Jiang, J., & Wang, X. (2016). Prenatal predictors in postpartum recovery for acute fatty liver of pregnancy: experiences at a tertiary referral center. Archives of gynecology and obstetrics, 293(6), 1185-1191. https://doi.org/10.1007/s00404-015-3941-5
Mikolasevic, I., Filipec-Kanizaj, T., Jakopcic, I., Majurec, I., Brncic-Fischer, A., Sobocan, N., … & Milic, S. (2018). Liver disease during pregnancy: a challenging clinical issue. Medical science monitor: international medical journal of experimental and clinical research, 24, 4080. https://doi.org/10.12659/MSM.907723
Mutlu, M. F., Aslan, K., Guler, I., Mutlu, I., Erdem, M., Bozkurt, N., & Erdem, A. (2017). Two cases of first onset intrahepatic cholestasis of pregnancy associated with moderate ovarian hyperstimulation syndrome after IVF treatment and review of the literature. Journal of Obstetrics and Gynaecology, 37(5), 547-549. https://doi.org/10.1080/01443615.2017.1286302
Naoum, E. E., Leffert, L. R., Chitilian, H. V., Gray, K. J., & Bateman, B. T. (2019). Acute fatty liver of pregnancy: pathophysiology, anesthetic implications, and obstetrical management. Anesthesiology, 130(3),446-461. https://doi.org/10.1097/ALN.0000000000002597
Niemeijer, M. N., Grooten, I. J., Vos, N., Bais, J. M., Van Der Post, J. A., Mol, B. W., … &
Painter, R. C. (2014). Diagnostic markers for hyperemesis gravidarum: a systematic review and metaanalysis. American journal of obstetrics and gynecology, 211(2), 150-e1. https://doi.org/10.1016/j.ajog.2014.02.012
Ozkan, S., Ceylan, Y., Ozkan, O. V., & Yildirim, S. (2015). Review of a challenging clinical issue: Intrahepatic cholestasis of pregnancy. World Journal of Gastroenterology: WJG, 21(23), 7134. https://doi.org/10.3748/wjg.v21.i23.7134
Pascual, Z. N., & Langaker, M. D. (2022). Physiology, pregnancy. In StatPearls [Internet]. StatPearls Publishing.
Ramanathan, R., & Ibdah, J. A. (2022). Mitochondrial Dysfunction and Acute Fatty Liver of Pregnancy. International Journal of Molecular Sciences, 23(7), 3595. https://doi.org/10.3390/ijms23073595
Rimaitis, K., Grauslyte, L., Zavackiene, A., Baliuliene, V., Nadisauskiene, R., & Macas, A. (2019). Diagnosis of HELLP syndrome: a 10-year survey in a perinatology centre. International journal of environmental research and public health, 16(1), 109. https://doi.org/10.3390/ijerph16010109
Rodger, M., Sheppard, D., Gándara, E., & Tinmouth, A. (2015). Haematological problems in obstetrics. Best Practice & Research Clinical Obstetrics & Gynaecology, 29(5), 671-684. https://doi.org/10.1016/j.bpobgyn.2015.02.004
Saha, S. (2019). Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum. In Gastrointestinal and Liver Disorders in Women’s Health (pp. 249-263). Springer, Cham. https://doi.org/10.1007/978-3-030-25626-5_16
Sahni A., & Jogdand, S. D. (2022). Effects of Intrahepatic Cholestasis on the Foetus During Pregnancy. Cureus, 14(10). https://doi.org/10.7759/cureus.30657
Sasamori, Y., Tanaka, A., & Ayabe, T. (2020). Liver disease in pregnancy. Hepatology Research, 50(9), 1015-1023. https://doi.org/10.1111/hepr.13540
Schalkwijk, H. H., Snoeck, R., & Andrei, G. (2022). Acyclovir resistance in herpes simplex viruses: Prevalence and therapeutic alternatives. Biochemical Pharmacology, 115322. https://doi.org/10.1016/j.bcp.2022.115322
Sharkey, L. C., & Radin, J. (2010). Manual of veterinary clinical chemistry: a case study approach. CRC Press.
Soma-Pillay, P., Nelson-Piercy, C., Tolppanen, H., & Mebazaa, A. (2016). Physiological changes in pregnancy: review articles. Cardiovascular journal of Africa, 27(2), 89-94. https://hdl.handle.net/10520/EJC188686
Terrault, N. A., Levy, M. T., Cheung, K. W., & Jourdain, G. (2021). Viral hepatitis and pregnancy. Nature Reviews Gastroenterology & Hepatology, 18(2), 117-130. https://doi.org/10.1038/s41575-020-00361-w
Townsend, R., O’Brien, P., & Khalil, A. (2016). Current best practice in the management of hypertensive disorders in pregnancy. Integrated blood pressure control, 9, 79. https://doi.org/10.2147/IBPC.S77344
Wegrzyniak, L. J., Repke, J. T., & Ural, S. H. (2012). Treatment of hyperemesis gravidarum. Reviews in obstetrics and gynecology, 5(2), 78. https://doi.org/10.3909/riog0176
Wood, A. M., Livingston, E. G., Hughes, B. L., & Kuller, J. A. (2018). Intrahepatic cholestasis of pregnancy: a review of diagnosis and management. Obstetrical & gynecological survey, 73(2), 103-109. https://doi.org/10.1097/OGX.0000000000000524
Ye, R., Mai, Z., Pan, X., Cai, S., & Deng, L. (2021). Acute fatty liver of pregnancy causes severe acute pancreatitis and stillborn fetus: A case report. Medicine, 100(16). https://doi.org/10.1097/MD.0000000000025524
Zhang, Y., Cantor, R. M., MacGibbon, K., Romero, R., Goodwin, T. M., Mullin, P. M., & Fejzo, M. S. (2011). Familial aggregation of hyperemesis gravidarum. American journal of obstetrics and gynecology, 204(3), 230-e1. https://doi.org/10.1016/j.ajog.2010.09.018
| Periodicity | Biannually |
| Issue-1 | May |
| Issue-2 | November |
| ISSN Print | 2321-2217 |
| ISSN Online | 2321-2225 |
| RNI No. | CHAENG/2013/50088 |
Publisher's policy of the journal at Sherpa UK for the submitted, accepted, and published articles. Click OAPolicy
Plan-S ComplianceTo check compliance, one has to use the Journal Check Tool (JCT). This tool provided by cOAlition S (European funders) for the researchers (fundee) to check the compliance with the journal.
Recommend journal to your libraryYou can recommend the journal being a researcher or faculty member to your library. We will post a copy of the Journal to your library on your behalf at free of cost.
Click here: Recommend Journal
The authors are encouraged to submit the author’s copy (preprint) to appropriate preprint archives e.g. https://arxiv.org and/or on https://indiarxiv.org or institutional repositories (e.g., D Space) before paper acceptance by the editor of Journal. After publications of the paper author(s) should mention the citation information, title and abstract along with DOI number of the publication carefully on the required page of the depository(ies).
Contact: Phone: +91-172-2741000, +91-172-4691800
Email : editor.jptrm@chitkara.edu.in;
This work is licensed under a Creative Commons Attribution 4.0 International License.
View Legal Code of the above-mentioned license, https://creativecommons.org/licenses/by/4.0/legalcode
View Licence Deed here https://creativecommons.org/licenses/by/4.0/
Journal of Pharmaceutical Technology, Research and Management by Chitkara University Publications is licensed under a Creative Commons Attribution 4.0 International License.
Based on a work at https://jptrm.chitkara.edu.in//
Chandigarh-Patiala National Highway, Punjab 140 401
Chandigarh Information Center SCO 160-161, Sector 9-C, Chandigarh 160 009
