What is Acute Fatty Liver of Pregnancy

Acute fatty liver of pregnancy (AFLP) is a rare, but serious, condition that can cause liver failure, as well as other life-threatening complications. It happens when too much fat builds up in your liver when you’re pregnant. It’s a medical emergency and involves delivering the fetus as soon as possible.

How common is acute fatty liver of pregnancy?

AFLP is rare. It affects about 1 in 10,000 to 20,000 pregnancies each year.

Diagnosis and Tests

How is acute fatty liver of pregnancy diagnosed?

Early diagnosis and quick treatment is essential as AFLP can lead to organ failure. The most accurate diagnostic tool is a liver biopsy, which involves your healthcare provider examining your liver tissue under a microscope. However, this isn’t always safe in pregnancy. Often, your pregnancy care provider can diagnose AFLP based on your symptoms and health history.

Your provider will order blood tests to look for AFLP. Results of your liver function blood test may raise a red flag and lead your provider to suspect AFLP. These tests often show signs of:

Higher levels of liver enzymes (elevated liver enzymes).
Problems with how your blood clots.
Increases of ammonia, uric acid and protein in your blood.
Low blood sugar values.
Evidence of kidney damage.

To make a diagnosis, your provider may also order an ultrasound or computed tomography (CT scan) to get a detailed view of your liver.

Management and Treatment

How is acute fatty liver of pregnancy treated?

Your pregnancy care provider will recommend delivery as soon as possible to avoid life-threatening complications. Your liver can begin healing itself once your provider removes the fetus and the placenta.

Prevention

What can I do to lower my risk of acute fatty liver of pregnancy?

AFLP is rare, and there isn’t anything you can do to prevent it or predict it.

Outlook / Prognosis

What can I expect if I have acute fatty liver of pregnancy?

AFLP requires immediate delivery. Your liver function typically returns to normal within 10 days of delivery. You may need to remain in the hospital under your provider’s care until your liver test values are in a typical range.

Your risk of getting AFLP again is unknown. Your provider may recommend genetic testing to see if any fatty acid abnormalities contributed to developing AFLP. They may also recommend a maternal-fetal medicine specialist monitor any future pregnancies.

What happens to the fetus?

In general, the more severe the disease is, the more effects it has on the fetus. Some children are at risk for developing nonketotic hypoglycemia, a condition that prevents them from processing amino acids. Others may have dilated cardiomyopathy or neuropathy. The risk to the fetus is usually less than the risk to the pregnant person.

Living With

When should I see my healthcare provider?

It’s important to share your complete medical history with your pregnancy care provider and let them know of any symptoms you have during pregnancy. Being transparent and honest with them is the best way to get the care you need during pregnancy.

Contact your healthcare provider if you feel any of the following symptoms during pregnancy:

Abdominal pain or pelvic pain that doesn’t go away.
Extreme tiredness or feeling unwell.
Nausea and vomiting.
Headaches that don’t go away.

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What questions should I ask my provider?

If your provider diagnoses you with AFLP, it’s normal to have lots of questions. You may want to ask:

Do I need to deliver right now?
Is my life at risk? Is my baby’s life at risk?
Will AFLP go away?
What treatments do I need?
Will this happen if I get pregnant again?
Do you know why this happened?

Additional Common Questions

How is acute fatty liver of pregnancy different from HELLP syndrome?

Hemolysis, Elevated Liver enzymes, and Low Platelet count syndrome (HELLP) is a condition during pregnancy that has similarities to AFLP. The main difference between the two conditions is seen in changes in blood work results over time. AFLP typically causes clotting issues as well as changes in platelet levels. HELLP syndrome typically causes a more progressive decline in platelet count. Additionally, people with AFLP are more likely to have:

Severe abnormalities in liver function tests.
Some evidence of abnormal blood glucose.
Signs of abnormal kidney function.
High bilirubin in lab tests. Bilirubin is a waste product.
Acidosis (a buildup of acid in your blood).
Proteinuria.
Changes to brain function like the inability to think clearly or becoming confused.

Is it normal to have fatty liver in pregnancy?

Fatty liver disease is a common, treatable condition in people who aren’t pregnant. Most people have some fat in their liver. However, fatty liver can progress to liver failure. During pregnancy, it’s especially dangerous because your liver removes toxins from your body. If your liver (or the fetus’s liver) isn’t functioning properly, harmful substances can clog your bloodstream.