There is an uneasy link between liver health and pregnancy. Multiple factors can lead to complications that could affect the health of both the mother and the baby, depending on other comorbidities and overall health of the individual. Experts opine that the liver starts influencing the reproductive and hormonal health of women as the liver is responsible for metabolising pregnancy hormones like estrogen.
Dr Krishanu Banik, Consultant, Gastroenterology and Hepatobiliary sciences, Fortis Hospital, Kolkata says that liver disease can increase the risk of complications during pregnancy, such as preeclampsia, gestational diabetes and premature delivery.
Dr Sangeetha Rajendran, Obstetrics and Gynecologist – Consultant, Promed Hospital, Chennai says that liver health should be closely monitored so as to avoid complications like uterine bleeding in women which is caused due to inability of liver to regulate estrogen level in the body.
Major liver complications and pregnancy
1. Intrahepatic Cholestasis of Pregnancy (ICP)
This is a serious liver disorder which may develop during pregnancy due to excess bile build up in the liver because of pregnancy hormones including estrogen and progesterone.
“During pregnancy, the bile is not secreted at its usual rate. So it gets held up and the liver becomes congested with retained bile,” says Dr Sanjeev Rohatgi, Lead Consultant – Liver Transplant & HPB Surgery, Manipal Hospital, Whitefield.
Dr Sonal Singhal, Senior Consultant , Obstetrician & Gynaecologist, Motherhood Hospital, Gurugram also says that it increases the risk of premature birth, stillbirth, excessive postpartum bleeding and fetal distress (when the baby does not get enough oxygen in the womb or due to inhaled meconium during childbirth).
2. HELLP syndrome
Hemolysis, Elevated Liver Enzymes, Low Platelet Count (HELLP) syndrome is a serious complication of high blood pressure during pregnancy. “It manifests either before the 37th week of pregnancy or shortly after delivery,” says Dr Singhal.
“This syndrome is not very common but could sometimes become fatal. The person may have to abort. The liver will not improve unless abortion is done when it is bad,” says Dr Rohatgi.
3. Hyperemesis gravidarum (HG)
It is a form of morning sickness. “The mother experiences severe nausea and vomiting, usually in the first trimester (which usually resolves spontaneously by 16 weeks),” says Dr Singhal.
“This could lead to lack of fluids in the body and the liver enzymes can increase leading to liver inflammation,” says Dr Rohatgi.
4. Acute fatty liver of pregnancy (AFLP)
It is a fatal complication that may occur during the third trimester or early postpartum period. “It happens due to a dysfunction in the oxidation of fatty acids in the liver,” says Dr Singhal.
“Fat gets accumulated in the liver for a person with this condition. During the third trimester, it becomes so fatty that the person can have liver failure,” says Dr Rohatgi.
5. Hepatitis B and hepatitis E
Hepatitis B and hepatitis E can be passed during delivery or a C-section. Dr Singhal adds that, if not treated or controlled during the earlier stages, these liver diseases pose a greater risk to both the baby and the mother ranging from liver failure, hemorrhage, kidney failure to severe infection which can be life-threatening.
Hepatitis E can easily be transmitted from the mother to the baby. “It is very common and can spread by eating unhygienic food and drinking contaminated water,” says Dr Rohatgi.
Liver complications could even cause miscarriage
“Severe cholestasis of pregnancy, HELLP syndrome or AFLP can lead to miscarriage or stillbirth. It can even be life threatening for the mother, so liver disorders in pregnancy need to be taken seriously,” says Dr Singhal.
Delivering the baby improves liver conditions like cholestasis and HELLP. Dr Singhal explains that after delivery, the physiology changes. The pregnancy hormones are withdrawn from the body and so symptoms of cholestasis and HELLP are reduced.
“Due to liver diseases spleen size will also become big, putting pressure on the growing fetus leading to miscarriage or stillbirth,” says Dr Joy Varghese, Director of Hepatology & Transplant Hepatology at Gleneagles Global Health City, Chennai. He adds that for people with advanced liver diseases, it is better to avoid pregnancy.
“When someone is affected by a liver disease while they are pregnant, maintaining a healthy diet consisting of fruits, vegetables and whole grains is important to avoid further risks,” says Dr Singhal. She adds that regular routine prenatal care is also crucial so that the doctor can evaluate your condition.
Liver medication during pregnancy
“In some cases, liver disease may also require medication that can be harmful to a developing fetus,” says Dr Banik.
“Some medicines can be safely used during pregnancy for symptomatic relief. Diet restriction and certain medicines like progesterone which put a load on the liver need to be avoided,” says Dr Singhal.
There is a serious link between liver health and pregnancy. It is important for women with liver diseases to take extra care during pregnancy. Mothers should take extra care if the disease can be transmitted to the fetus. Proper diet and lifestyle, along with medications is necessary for a healthy mother and baby.