Liver and Gallbladder Disorders During Pregnancy

The normal hormonal effects of pregnancy can slow the movement of bile through the bile ducts. This slowing is called cholestasis.

Cholestasis of pregnancy can increase the risk of the following:

• Premature birth

• Stillbirth

• Passage of stool (meconium) by the fetus before birth, which can lead to breathing problems in the fetus (called meconium aspiration syndrome)

The most obvious symptom of cholestasis of pregnancy is intense itching all over the body (usually in the 2nd or 3rd trimester). No rash develops. Urine may be dark, and jaundice may develop.

For intense itching, a medication called ursodeoxycholic acid, taken by mouth, may be prescribed.

Cholestasis of pregnancy usually resolves after delivery but tends to recur in subsequent pregnancies or with use of oral contraceptives.

Cirrhosis (scarring of the liver) increases the risk of miscarrying or giving birth prematurely.

Cirrhosis can cause varicose veins (widened, convoluted veins) to develop around the esophagus (called esophageal varices). Pregnancy slightly increases the risk that these veins will bleed profusely, especially during the last 3 months of pregnancy.

This rare disorder can develop toward the end of pregnancy. The cause is unknown.

Symptoms of fatty liver of pregnancy include nausea, vomiting, abdominal discomfort, and jaundice. The disorder may rapidly worsen, and liver failure may develop. Preeclampsia (a type of high blood pressure that develops during pregnancy) sometimes results.

Diagnosis of fatty liver of pregnancy is based on results of the doctor's evaluation, liver tests, and other blood tests and may be confirmed by a liver biopsy. The doctor may advise women to immediately end the pregnancy.

The risk of death for pregnant women and the fetus is high in severe cases. Consequently in such cases, doctors may recommend that the baby be delivered promptly or the pregnancy be terminated. Women who survive recover completely. Usually, fatty liver of pregnancy does not recur in subsequent pregnancies.

Gallstones appear to be more common during pregnancy. Pregnant women who develop gallstones are closely monitored.

If a gallstone blocks the gallbladder or causes an infection, surgery may be necessary. This surgery is usually safe for pregnant women and the fetus.

Acute viral hepatitis may increase the risk of premature birth. It is also the most common cause of jaundice during pregnancy. Pregnancy does not worsen most types of hepatis (hepatitis A, B, C, and D), but hepatitis E may become more severe during pregnancy.

Hepatitis B may be transmitted to the baby immediately after delivery or, less often, during the pregnancy. Most infected babies have no symptoms and have only mild liver dysfunction. But they may become carriers of the infection and transmit it to others. All pregnant women are tested for hepatitis, and if they are infected, measures are taken to prevent the baby from being infected.

Women with chronic hepatitis, especially if cirrhosis is present, may have difficulty becoming pregnant. If they become pregnant, they are more likely to miscarry or to give birth prematurely. If these women were taking corticosteroids before the pregnancy, they can continue to take these medications during pregnancy. Sometimes, when the infection is severe, women with chronic hepatitis are given antiviral medications during the 3rd trimester. These medications may reduce the risk of transmitting the hepatitis virus to the fetus.