Non alcoholic fatty liver disease (NAFLD) is the liver manifestation of the metabolic syndrome and is the commonest liver disease in the western world. It has never been reported in pregnancy before.
Abnormalities in liver function tests(LFTs) during pregnancy are common, and may be due to pregnancy-specific disorders (pre-eclampsia, HELLP syndrome, obstetric cholestasis, hyperemesis gravidarum, acute fatty liver of pregnancy) or to conditions coincidental to pregnancy such as viral hepatitis, cholelithiasis, autoimmune liver disease etc. The authors suggest that now NAFLD should also be considered.
The authors have diagnosed NAFLD in 5 women during or shortly after pregnancy. All had otherwise unexplained LFTs (negative screen for viral hepatitis and liver autoantibodies, normal bile acids; none had pre-eclampsia); all had a raised BMI. In 4, the diagnosis was made when liver US showed fatty change: 2 in the 2nd trimester (in one, LFTs deteriorated after delivery; in one, LFTs normalized], 2 postnatally [in both LFTs deteriorated after delivery). One woman had a diagnostic liver biopsy postnatally when LFTs deteriorated.
As NAFLD is driven by insulin resistance, it is biologically plausible that pregnancy – “the stress test for life” – may reveal previously subclinical disease; this is not yet clear. But it is clear that obstetricians have a vital role in optimizing maternal health during and after pregnancy: the authors now need to include NAFLD in the differential diagnosis for abnormal LFTs and use the therapeutic window to initiate lifestyle modifications (weight loss, dietary changes, exercise), which are key in preventing progression to cirrhosis and hepatocellular carcinoma.
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