Every mother wants to give birth to a healthy child and ensure her health is at its best. However, certain conditions can make this journey difficult. One such condition is Acute Fatty Liver of Pregnancy (AFLP). AFLP is a severe obstetric emergency that can lead to serious complications for both the mother and the baby, including death. It is characterised by liver dysfunction and failure that occurs during pregnancy. 

In this article, we will understand Acute Fatty Liver of Pregnancy (AFLP), recognise its symptoms and know the risk factors and complications associated with AFLP. We will also discuss its diagnosis, treatment, and prevention.

Causes of Acute Fatty Liver of Pregnancy

The exact cause of fatty liver during pregnancy is unknown but may relate to how the body processes fats during pregnancy. 

• It may be due to defects in fat metabolism, leading to fat buildup in the liver and potentially leading to liver failure, which can be life-threatening for both the mother and baby.
• Liver damage can result from infections and inflammatory conditions, and if untreated, this damage can progress to cirrhosis and liver failure. 

Signs and Symptoms of Acute Fatty Liver of Pregnancy

The initial symptoms of AFLP are often nonspecific and include:

• Nausea or vomiting
• Pain in the right side of the upper abdomen
• Generalised tiredness or malaise
• Headache
• Loss of appetite

Once acute liver failure sets in, these signs and symptoms are noticed:

• Jaundice
• Swelling in the abdomen (ascites), legs and ankles
• Easy bruising or bleeding (disseminated intravascular coagulopathy)
• Hypoglycemic episodes
• Neurological symptoms like confusion, disorientation, and seizures.

Risk Factors of Acute Fatty Liver of Pregnancy

The following factors may increase the risk of developing AFLP. However, it is important to understand that most women with these risk factors do not necessarily develop AFLP.

• Women carrying multiple fetuses (twins or more) have increased chances of getting acute fatty liver during pregnancy. 
• Some women might be more likely to get acute fatty liver during pregnancy (AFLP) because of their genes. Having specific genes can make a woman more prone to developing this condition during pregnancy.
• Pre-existing medical conditions like obesity and diabetes increase the chances of acute fatty liver during pregnancy (AFLP).
• Preeclampsia or hemolysis, elevated liver enzymes, and a low platelet count syndrome also lead to acute fatty liver during pregnancy.
• Intake of high-fat and low-protein diets can lead to acute fatty liver during pregnancy.

How is AFLP Diagnosed?

Early diagnosis is crucial to prevent complications. Doctors diagnose AFLP through blood tests and imaging studies. The diagnosis process involves: 

• Liver Function Tests (LFTs): Your doctor will suggest this test to measure levels of liver enzymes such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Elevated levels may indicate liver inflammation or damage.
• Fasting Blood Glucose and Hemoglobin A1c: The doctor will check for diabetes or pre-diabetes. Elevated levels may indicate these conditions.
• Lipid Profile: The doctor will check cholesterol and triglyceride levels.
• Complete Blood Count (CBC): The doctor will check for anaemia (low hemoglobin) or other blood abnormalities.
• Ultrasound: Ultrasound is suggested to identify steatosis (fat build-up in liver) but cannot distinguish between simple steatosis and steatohepatitis (fat accumulation and liver inflammation).
• Computed Tomography (CT) Scan: The doctor will suggest this to detect liver fat.
• Magnetic Resonance Imaging (MRI): It is more accurate than ultrasound and CT in quantifying liver fat. The doctor will suggest this to assess liver stiffness, indicating fibrosis.

How is AFLP Treated?

Managing AFLP involves three main steps - diagnosing it early, delivering the baby quickly, and giving full medical care. Doctors need to be very alert to recognise AFLP quickly and avoid delays in treatment. Also,

• Patients need to communicate with the doctor if they are experiencing symptoms such as abdominal pain, nausea, vomiting, and jaundice.
• Treatment involves delivering the baby to relieve stress on the mother’s liver, along with supportive care to stabilise her condition.
• The liver function typically returns to normal within ten days of delivery, although might take longer in some patients.. Patients may be hospitalised until their liver test values are in the normal range.

Prevention of AFLP

While the exact cause of AFLP remains unknown, some preventive measures can be taken to minimise the risk:

• Maintain a healthy weight before and during pregnancy to reduce the chances of developing this condition.
• Eat a balanced diet containing many fruits, vegetables, and whole grains. Limit processed foods, unhealthy fats, and excessive sugar intake.
• Engage yourself in moderate physical activity during pregnancy.
• Avoid alcohol and smoking during pregnancy.
• If you have pre-existing diabetes or gestational diabetes, you may be at a higher risk of AFLP. Get regular blood sugar check ups done to prevent complications.

Complications of AFLP

Maternal Complications

• Liver Failure: Severe liver dysfunction can lead to liver failure, which may require intensive medical treatment or even a liver transplant in extreme cases.
• Kidney Failure: AFLP can lead to acute kidney injury, leading to kidney failure and the need for dialysis.
• Coagulopathy: Blood clotting issues can occur, increasing the risk of severe bleeding during and after delivery.
• Hypoglycemia: Low blood sugar levels can lead to confusion, seizures, and other serious issues if not promptly treated.
• Infection: The weakened state of the body can increase the chances of infections.
• Pancreatitis: Inflammation of the pancreas can occur, causing severe abdominal pain and digestive issues.

Fetal Complications

• Preterm Birth: Doctors suggest early delivery of the baby to manage AFLP, which can lead to complications related to preterm birth.
• Fetal Distress: The baby may experience distress due to the compromised health of the mother and the need for early delivery.
• Stillbirth: In severe cases, AFLP can lead to fetal death in the womb if not managed promptly.

Conclusion

Acute Fatty Liver of Pregnancy (AFLP) is a condition that occurs during pregnancy, and if not managed well, it can put both the mother’s and baby’s lives at risk. It is characterised by liver dysfunction and failure of the liver. The exact cause of AFLP is unknown, but it may relate to how the body processes fats during pregnancy. 

However, AFLP can be managed and treated with proper medical care. Managing AFLP involves three main steps: diagnosing it early, delivering the baby quickly, and providing comprehensive medical care. Doctors need to be very alert to recognise AFLP quickly and avoid delays in treatment. Preventing AFLP involves maintaining a healthy weight before and during pregnancy to reduce the chances of developing this condition. Eating a balanced diet rich in fruits, vegetables, and whole grains while limiting processed foods, unhealthy fats, and excessive sugar intake is important. Engaging in moderate physical activity during pregnancy and avoiding alcohol and smoking can also help prevent AFLP.

Apollo 24|7 provides access to obstetricians, gastroenterologists, hepatologists, and neonatologists who can guide patients through proper care and treatment plans.