Pregnancy fatty liver is a serious complication that can be potentially life-threatening for both mother and child. What causes fat to be stored in the liver cells of pregnant women has not yet been clearly clarified. Treatment consists of timely termination of pregnancy. In most cases, the liver regenerates completely in the weeks after birth.
What is pregnancy fatty liver?
Pregnancy fatty liver is a rare complication that leads to severe liver dysfunction in the expectant mother. There is an excessive storage of fat in the cells of the liver (hepatocytes), which means that the liver can only carry out its varied tasks to a limited extent. See bestitude for Meanings of Carotid Stenosis (abbreviated as Narrowing of the Carotid Artery).
Typically, symptoms do not become apparent until the last trimester and can be life-threatening. Pregnancy fatty liver is basically reversible; all symptoms resolve after delivery. The frequency of this pregnancy complication is estimated to be between 1:7000 and 1:16000.
Exact figures are not available due to the rarity of this hepatological disease. Diagnosis is a major challenge for the treating physicians. Physicians from different disciplines such as hepatology, neonatology, surgery and gynecology must work together to rule out possible other diseases.
The exact causes of the development of fatty liver during pregnancy are still unclear. A genetic predisposition may play a role in its development. This complication occurs more frequently in some families, which indicates that hereditary factors are involved.
In addition, taking certain medicines, such as antiepileptics, can increase the risk of developing the disease. In exceptional cases, the disease could be associated with the use of antibiotics during pregnancy. In this hepatological disease, the breakdown of fatty acids, the so-called beta-oxidation, in the cells of the liver is disturbed.
Fatty acids cannot be broken down and metabolized properly, resulting in a build-up of fat in the hepatocytes. If this process is not stopped, more and more fat accumulates in the liver until liver failure occurs. The exact pathogenesis is unknown. In rare cases, an enzyme defect in the fetus plays a role in the development of gestational fatty liver.
Symptoms, Ailments & Signs
Acute fatty liver during pregnancy usually does not appear until around the 35th week of pregnancy and is accompanied by many non-specific symptoms. Affected women often suffer from upper abdominal pain, loss of appetite, tiredness, headaches, nausea and vomiting.
Persistent back pain can also occur. The symptoms usually start out mildly and increase in intensity over time. In an advanced stage, jaundice occurs, in which case the skin, especially the conjunctiva of the eyes, turns yellow. Affected women usually have a very fast heartbeat. The liver is responsible for producing the coagulation factors in the blood.
If the liver function is impaired, problems with blood clotting can therefore occur. Affected women show punctiform hemorrhages in the skin. Mucous membranes are often affected by these small hemorrhages. There is an increased tendency to bleed during childbirth.
In severe cases, pregnancy fatty liver leads to bleeding in the digestive tract, renal insufficiency and hepatic encephalopathy with coma. This can lead to the death of the expectant mother and the unborn child. Such serious courses are rare, since the pregnancy is usually terminated before the condition of the pregnant woman worsens.
Diagnosis & course of disease
Due to the non-specific symptoms, the diagnosis of pregnancy fatty liver is complex and time-consuming. In advanced pregnancy and symptoms of liver dysfunction, a blood test is done first. An ultrasound examination is not always conclusive.
If there is no coagulation disorder, the diagnosis can be made by a biopsy of the liver and subsequent histological examination. Pregnancy fatty liver is a serious condition that, if left untreated, can result in the death of the mother and child. With prompt treatment, however, the prognosis is positive.
The complications associated with it are just as rare as the pregnancy fatty liver itself. However, if they do occur, they can have serious repercussions.
Possible consequences of pregnancy fatty liver only become apparent in the last section of pregnancy. On average, this is the 35th week of pregnancy. The women affected initially often suffer from loss of appetite, tiredness, nausea, vomiting, headaches, back pain and painful symptoms in the upper abdomen. Other effects include a yellow discoloration of the skin and the conjunctiva and an accelerated heartbeat.
If the pregnancy fatty liver progresses intensively, there is a risk of complications such as renal insufficiency (kidney weakness) and bleeding within the gastrointestinal region. In extreme cases, the pregnant woman can fall into a coma. Because the liver and blood coagulation functions are also affected by the pregnancy fatty liver, blood coagulation disorders sometimes occur.
They become noticeable in the form of small, punctiform bleeding on the skin and mucous membranes. Major bleeding is possible during the birth process. Extensive bruising can also form on the liver. Due to the associated increase in pressure, there is a risk of liver rupture.
The effects of acute pregnancy fatty liver also include serious metabolic disorders such as a lower concentration of sodium and potassium in the blood, hypoglycaemia or the breakdown of protein. In some cases, acute pancreatitis develops. In the worst case, these serious complications can even result in the death of the pregnant woman or her child.
When should you go to the doctor?
A pregnancy fatty liver must always be treated immediately by a doctor. It is a serious condition that, if left untreated, can lead to serious complications and symptoms. The earlier the pregnancy fatty liver is recognized and treated, the better the further course. A doctor should be consulted if the affected person suffers from severe pain in the stomach or from a severe loss of appetite.
This can also lead to significant tiredness, nausea or severe headaches. Furthermore, frequent vomiting can also indicate pregnancy fatty liver and should be examined by a doctor if it occurs permanently and does not go away on its own. In many cases, there are skin problems, jaundice or severe back pain. You should always consult a doctor if you have these symptoms.
In the case of pregnancy fatty liver, a gynecologist or a general practitioner is usually consulted. Further treatment then takes place in a hospital. In most cases, if diagnosed early, the disease can be treated relatively well without affecting the life expectancy of the mother and child.
Treatment & Therapy
The only causal therapy for pregnancy fatty liver is to induce labor. Depending on the situation and the state of health of the pregnant woman, labor can be induced with drugs or a caesarean section can be performed. The child is usually born as soon as possible to prevent acute liver failure in the pregnant woman.
Since it is a serious complication, affected women are mainly treated in the intensive care unit. This is necessary, among other things, because the state of health can deteriorate very quickly and immediate action is required. A blood transfusion may be necessary.
The administration of coagulation factors is particularly important in the case of advanced fatty liver in order to counteract the tendency to bleed. After delivery, the newborn is examined for enzyme defects and, if necessary, further treatment is initiated. If the delivery is initiated early enough, the disease usually resolves quickly and the pregnant woman can leave the hospital a few weeks after the birth.
In severe cases, liver function may not improve postpartum. If there is acute liver failure, only a liver transplant can save the woman’s life. After recovery, affected women must be informed about the risk of recurrence in the event of another pregnancy.
It is not currently known exactly what leads to the development of fatty liver during pregnancy. Targeted prevention is therefore not possible. If there are known cases of hepatological complications during pregnancy in the family, this should be discussed with the attending gynecologist at a preventive examination.
Under certain circumstances, close check-ups are then necessary in the last trimester of pregnancy. In addition, taking medication during pregnancy should always be discussed with a specialist in gynaecology. In general, the condition is so rare that it is not a cause for concern for most pregnant women.
Since pregnancy fatty liver is a disease that occurs temporarily in connection with pregnancy, it is quite possible that it will regress on its own after childbirth. The body can adjust to normal metabolism again.
Follow-up care varies greatly depending on the course of the disease. Check-ups are required and regular blood tests to determine liver values. This allows the course and healing to be seen very well. The sonographic examination can also provide information on the healing process.
However, it is to be expected that the body will also need some time after pregnancy to regulate the processes and break down the fat stored in the liver. In difficult cases, a consistent change in lifestyle may be necessary. This relates in particular to diet and the increase in sporting activities.
Even after the pregnancy fatty liver has healed, a healthy lifestyle should be continued. For this purpose, the doctor treating you can provide appropriate tips and assistance as part of the follow-up examinations. Complicated courses with strong weight gain and persistent fatty liver disease should always be observed and treated by an experienced gastroenterologist, as recurring symptoms can occur here.
You can do that yourself
This disease, which is life-threatening for women and their unborn baby, occurs only rarely. However, she is forcing the doctors to act: the child must be carried to term as soon as possible so that there are no severe courses with serious complications. The mothers concerned are therefore well advised to agree to the premature induction of labor.
In most cases, all of the symptoms associated with fatty liver during pregnancy go away after the child is carried to term, and are therefore reversible. Nevertheless, it is advisable to continue to pay attention to your own liver health after your stay in hospital. The liver is a detoxification organ. In order not to burden them unnecessarily, as few toxins as possible should be absorbed. Alcohol, nicotine, food that is too fatty or too sweet are just as taboo as the indiscriminate use of medication. Over-the-counter medicines can also put a strain on the liver.
Naturopaths recommend drinking a lot of green tea for liver detoxification because it is said to be able to dissolve and drain fat in the liver. Artichokes are also considered liver protectants. Detoxification measures also relieve the liver. Anything that makes you sweat is recommended, such as saunas, steam baths or sports. Food also has a detoxifying effect. Turmeric, a curry spice, is thought to boost detoxification. But asparagus and fruit rich in water also help to flush out unnecessary toxins in the body.