Acute Fatty Liver of Pregnancy

AFLP is a rare, but serious, condition of pregnancy in which there is an excessive accumulation of fat in the liver or liver cells. Fat normally accumulates in the liver in the form of triglycerides and fatty acids, but excessive fat can cause liver damage. AFLP is quite rare, however, it is a serious condition that cannot be predicted or prevented.

The exact cause of AFLP is unknown. Recent advances in research indicate that AFLP may be the result of a mitochondrial dysfunction in the oxidation of fatty acids in the liver--in particular, a deficiency of long-chain 3-hydroxyacyl-CoA dehydrogenase, an enzyme used in the breakdown of long chain fatty acids. Although the risk of acute fatty liver in subsequent pregnancies is not known, it can occur again in future pregnancies, even if the woman is negative for the long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) mutation.

Both mother and fetus are at extremely high risk if AFLP is not treated. Liver failure, hemorrhage, kidney failure, and severe infection can be life-threatening for the mother and fetus. Fortunately, early diagnosis and treatment helps to improve outcomes.

AFLP usually begins late in the third trimester of pregnancy. The following are the most common symptoms of AFLP. However, each woman may experience symptoms differently. Symptoms may include:

• Nausea and vomiting

• Abdominal pain, especially in the right upper side

• Malaise (general discomfort)

• Headache

• Tiredness

• Confusion

• Jaundice (yellow coloring of skin, eyes, and mucous membranes)

The symptoms of acute fatty liver of pregnancy may resemble other medical conditions. Always consult your doctor for a diagnosis.

In addition to a complete medical history and physical examination, diagnosis of AFLP is most accurate by liver biopsy (taking a sample of liver tissue for examination under a microscope), but this is not always possible in pregnancy. Usually, the symptoms of AFLP are often clear enough to diagnose the condition. Blood tests can rule out other conditions or diseases that have similar symptoms. Ultrasound (a diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs) or computed tomography (CT) scan (a diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images, often called slices, of the body) may also be used for diagnosis.

Once the condition is diagnosed, the baby is delivered as quickly as possible to minimize the risks to mother and baby. The mother may require intensive care for several days after delivery until her condition improves. In most cases, liver function returns to normal within a few weeks.