Acute fatty liver of pregnancy occurs when excess fat accumulates on your liver. This condition is very rare but is considered a pregnancy emergency if it happens.

Share on Pinterest
AsiaVision/Getty Images

Acute fatty liver of pregnancy is a rare but extremely serious condition in which excess fat accumulates on your liver during pregnancy. If left untreated, it can cause complications such as:

  • multiple organ failure
  • sepsis
  • liver failure
  • death of the pregnant person or the fetus

According to the National Library of Medicine, due to advancements in medicine, the rate of maternal death from this condition has decreased to 4%.

Acute fatty liver of pregnancy is extremely rare, affecting only about 5 of every 100,000 pregnancies. Still, prompt diagnosis and treatment of the condition are vital to increase the chances of survival.

Let’s take a closer look at acute fatty liver of pregnancy, including symptoms, diagnosis, treatment, and the outlook for people who have this condition.

Acute fatty liver occurs when excess fat accumulates on your liver during pregnancy, leading to serious and life threatening complications. The condition usually begins in the third trimester of pregnancy and is thought to affect 1 in every 7,000–15,000 pregnancies.

The exact cause is unclear, but experts believe it’s related to problems with metabolizing fatty acid during pregnancy. Because the condition is quite serious, the treatment involves delivering the baby as soon as possible.

Symptoms of the condition may be less specific at first and resemble those of other pregnancy-related conditions. But they may become more serious.

Early symptoms may include several days or weeks of feeling generally unwell and exhausted. Appetite loss is also common.

As time goes on, symptoms may include:

  • nausea
  • vomiting
  • stomach pain
  • headache
  • swelling
  • high blood pressure
  • yellowing of the skin (jaundice)
  • increased thirst
  • itchy skin
  • abdominal fluid buildup
  • memory loss or confusion
  • tremors
  • increased susceptibility to bleeding or bruising

The precise cause of acute fatty liver of pregnancy is not known, though the condition is thought to be caused by problems with fatty acid processing during pregnancy. Free fatty acids typically increase toward the end of pregnancy, but if you have acute fatty liver of pregnancy, they accumulate in unusual ways and in your liver cells.

People who develop acute fatty liver of pregnancy may have certain metabolic mutations, such as:

  • long-chain 3 hydroxy acyl CoA dehydrogenase deficiency
  • homozygous G1528C mutation
  • mutations in various enzymes that process fatty acids in your body

Acute fatty liver of pregnancy is rare and can affect anyone. But you may have a greater risk of developing this condition if you:

  • are pregnant for the first time
  • are pregnant with multiples
  • are pregnant with a male fetus
  • have received a diagnosis of another liver condition during pregnancy
  • have a history of acute fatty liver of pregnancy
  • have preeclampsia
  • have HELLP syndrome

Acute fatty liver of pregnancy is considered an emergency condition because of the complications that can occur.

Possible complications of the condition include:

  • acute liver failure
  • hemorrhage
  • kidney failure
  • infections and sepsis
  • pancreatitis
  • acute respiratory distress
  • death of the pregnant person or the fetus

According to the American College of Gastroenterology, people with acute fatty liver of pregnancy should deliver their babies as soon as possible. A “wait and see” approach is not recommended.

As soon as healthcare professionals diagnose acute fatty liver of pregnancy, they will provide supportive treatment, including balancing of electrolytes and therapy for low blood sugar and abnormal blood clotting. You and your baby will be carefully monitored as you wait for delivery.

As serious as acute fatty liver of pregnancy is, survival rates have increased substantially. In the past, the maternal death rate for the condition was as high as 75%, but now it is 5% or less.

The fetal loss rate for pregnancies affected by acute fatty liver of pregnancy is 10–20%, with most deaths caused by stillbirth.

If your doctor suspects that you have acute fatty liver of pregnancy, they will start by running a series of blood tests. These tests will determine your white blood cell count as well as your levels of:

  • liver enzymes (AST and ALT)
  • bilirubin
  • creatinine
  • platelets
  • blood sugar
  • ammonia

Your doctor may also ask for a urine sample to look for protein in your urine.

Although liver biopsies are the most definitive way to get a diagnosis, healthcare professionals do not routinely do them for acute fatty liver of pregnancy. Imaging tests such as ultrasound and MRI may be used to check the appearance of the liver for signs of the condition.

Acute fatty liver of pregnancy is not preventable. If you’ve had acute fatty liver of pregnancy in prior pregnancies or have a family history of the condition, make sure to discuss this with your healthcare professional.

How long does it take to recover from acute fatty liver of pregnancy?

Most people with acute fatty liver of pregnancy recover within 1–4 weeks of giving birth.

When do symptoms of acute fatty liver of pregnancy start?

Symptoms of acute fatty liver of pregnancy usually start during the third trimester. But at times, symptoms may start at the end of the second trimester or even in the postpartum period.

How will I deliver my baby if I have acute fatty liver of pregnancy?

Induction followed by vaginal delivery is possible, but cesarean delivery is often necessary due to complications in the pregnant person and the fetus.

Acute fatty liver of pregnancy is a rare but very serious condition. If left untreated, it can cause severe complications, including the death of the pregnant person or the fetus.

Prompt treatment decreases the chances of an unfavorable outcome. It’s important to keep up with your prenatal appointments and report any usual symptoms to your healthcare team.