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Pregnancy and Your Liver

Are There Changes in The Liver During Pregnancy?

Although there can be alterations in certain liver function indicators during a normal pregnancy, there is no significant change in liver function. An example of this is a reduction in albumin levels in the blood due to that blood dilutes during pregnancy. Alkaline phospatase levels also increase due to the fact that this liver disease indicator is produced by a normal placenta. However, this does not verify the liver disease and pregnancy has little effect on a normal liver.

When Does the Liver Start to Function and How does it Develop in the Fetus?

Liver function of the fetus begins between 6 and 10 weeks of pregnancy, although the liver is usually observed as early as the 3rd week of pregnancy. As liver function develops over the time for pregnancy, the infant's liver will only mature enough to process compounds such as bile acids and bilirubin after the time of birth. Except for the fact that the child's liver is smaller in comparison to an adult liver, its functions are basically the same of an adult liver.

Is it Necessary to Be Tested for Hepatitis During Pregnancy?

There are measures that can be taken at time of birth and babies can be vaccinated and administered a special preparation of gamma globulin. Yet, the best preventive measure is to test the mother for hepatitis B during the last 2-3 months because infants born to women with virus would be at a high right of being infected at time of delivery. On the other hand, although the transmission of hepatitis C through childbirth is not likely, there is always the possibility. Unfortunately, there is no preventive treatment at this time.

Is it Safe to Breast-feed Your Baby if You Have Hepatitis B or C?

Although it is not certain if HCV can be transmitted though breast milk, the risk apparently is low. Mothers with HBV can breast-feed, more so if the infant has been vaccinated.

How Safe Are Treatments for Hepatitis During Breast-feeding?

It is recommended that any treatment begin after pregnancy and breast feeding is over. Treatment is also contraindicated if there is a possibility of pregnancy. Appropriate contraception is indicated once treatment is started.

What Causes Itching and Jaundice in Some Women?

These are caused by elevated estrogen hormones and are often related to an impairment in bile flow, caused by a change in the ability of the liver to process bilirubin and bile acids. Although this disorder is generally mild to moderate and itching may bring discomfort to the mother, neither the mother nor the baby will have further complications.

Do Oral Contraceptives Affect the Liver?

At normal levels estrogens do not interfere with the formation of bile, yet oral contraceptives may produce decreased bile flow (cholestasis), itching and jaundice in females who are genetically susceptible to changes in estrogen levels. They may also cause an increase in the growth of liver cell adenomas. However, these benign liver tumors are uncommon and do not spread outside the liver. For most women in general oral contraception has very little effect on the liver.

Can Women Drink Moderate Amounts of Alcohol During Pregnancy?

Although the consumption of one or two drinks may not affect the liver of a normal woman, during pregnancy it could cause damage to the fetus and it is, therefore, not recommended.

What is Toxemia - Also Known as Pre-Eclampsia?

The consequences of toxemia can vary from mild to severe, affecting the liver in only about 10% of women diagnosed with this condition. This disorder occurs towards the last stages of pregnancy with symptoms including, swelling of the legs or edema, kidney dysfunction and high blood pressure. Since it reduces the flow of blood to the placenta, it can be dangerous for the fetus, as it restrict your baby's growth because not enough oxygen or nutrients get through. In severe case, bleeding into the liver and blood clots may develop, damaging or destroying large parts of the liver.

What Are The Complications with Autoimmune Hepatitis?

Women with autoimmune hepatitis should be treated and their disease controlled before becoming pregnant. When active, autoimmune hepatitis diminishes fertility and may produce many complications during pregnancy. The treatment usually prescribed is an anti-inflammatory drug known as prednisone, which suppresses the immune system and is considered safe during pregnancy. Treatment should be continued throughout pregnancy to avoid flare-ups. Uncontrolled autoimmune hepatitis and cirrhosis may present serious complications to the mother and put the infant at risk for fetal death or premature birth.

How Does Wilson's Disease Affect Pregnancy?

It is very difficult for women with uncontrolled Wilson's Disease to become pregnant. This disease causes the body to store excessive amounts of copper, making it toxic to the liver and other organs. Women with this inherited defects may experience spontaneous abortions and miscarriages and are considered at high risk of complications during pregnancy. However, in cases where the disease is well controlled and copper levels have been reduced, there is the possibility of normal, full-term pregnancy and childbirth. A low-copper diet may also be recommended, which involves avoiding mushrooms, nuts, chocolate, dried fruit, liver, and shellfish.

What is a Syndrome Known as HELLP?

HELLP is an abbreviation of: Hemolytic anemia (when red blood cells break down), Elevated Liver transminases (sign of liver problems), Low Platelet count (causing problems in blood clotting). Approximately 10% of women with pre-eclamsia are diagnosed with this syndrome. Although it can range from mild to severe, this syndrome ends immediately after childbirth. During the course of this disease, however, there are the risks of complications due to liver damage and bleeding, and the risk of premature delivery or stillbirth.

Can Cirrhosis Interfere With Pregnancy?

Although it is more difficult for a woman with cirrhosis to become pregnant, full-term pregnancy and delivery of a healthy baby is possible. However, women with cirrhosis should take into consideration the fact that they may experience the complications of liver failure. There is also the possibility of miscarriage, spontaneous abortion, premature delivery or stillbirth.

What Other Conditions Are There That Can Affect Pregnant Women and Their Babies?

There are three rare liver disorders that may lead to serious consequences during pregnancy: toxemia-related disease due to HELLP syndrome; impaired bile flow (intrahepatic cholestasis); and acute fatty liver. Also, women with severe liver damage such as cirrhosis and liver dysfunction are less fertile and are at high risk during pregnancy. Finally, there are some less common disease (primary sclerosing cholangitis, primary biliary cirrhosis, alcoholic liver disease) where pregnancy may be considered.

Is it Safe for Women With Liver Transplants to Become Pregnant?

Although relatively few women with liver transplants have gone on to become pregnancy, it does not seem to have impaired their ability for full-term pregnancy and normal delivery. In terms of the immunosuppressant drugs used to avoid rejection after transplantation, although they are thought to be safe for the fetus, this cannot be absolutely guaranteed.

© Copyright August 2001 - The Latino Organization for Liver Awareness, Revised: March 2009