The Link Between Liver Disease and Pregnancy: Are You at Risk?

Pregnancy can be risky. Even if you are in tip-top shape, things can still go wrong. But what happens when liver disease is added into the mix?

While quite rare, liver disease can be prevalent in 3-10% of all pregnancies (1). You can even develop liver disease during pregnancy! But if you already have liver disease, could that affect your pregnancy? The short answer is yes — having liver disease can increase your risk of complications before, during, and after the pregnancy (2).

The liver is your body’s largest internal organ, and it has multiple functions, including filtering your blood, getting rid of toxins, and producing bile to aid in digestion. When it comes to the liver’s role in pregnancy, it makes, balances, and guides hormones throughout your body. When you’re pregnant, the amount of these hormones can increase, which can cause issues in your liver (3). But before we dive into how liver disease affects pregnancy and vice versa, let’s first see how a normal liver is affected during a healthy pregnancy. 

Changes in the Liver During Pregnancy

How your liver functions during pregnancy is bound to be different from when you’re not pregnant. Many changes happen to the body when pregnant, such as (1):

● Increased cardiac output

● Raised hormone levels

● Reduced blood pressure

● Decreased total protein levels

Hormones like estrogen and progesterone increase in the body, which give the liver a lot more work to do. Your liver produces bile, and that process can become interrupted, causing nausea, digestion issues, and vomiting (commonly referred to as morning sickness). Vascular spiders (spider veins) are also common occurrences, with up to 66% of expectant mothers developing them by the ninth month of pregnancy (4). The appearance of these veins often disappear about seven weeks after delivery. 

These types of symptoms should not be ringing any alarm bells, as they are perfectly normal in a healthy pregnancy! Your body is expected to be under a lot of stress at this time, which can in turn put more weight on your liver. But when should you start to be concerned? 

Liver Diseases Caused by Pregnancy

Unfortunately, because of the extreme burden a developing baby can bring onto the body, being pregnant can actually cause permanent liver damage and disease. Some of these diseases are: 

● Metabolic Dysfunction-Associated Steatotic Liver Disease: Occurs in the third trimester and can be fatal for both mother and child if not caught early enough, with a 20% possibility of the disease continuing on after pregnancy (2). 

● Budd-Chiari Syndrome: Is caused by the blockage of hepatic veins.

● Intrahepatic Cholestasis: Develops from the disruption of bile flow. 

● Autoimmune Hepatitis: Can cause flare-ups during pregnancy.

● Wilson’s Disease: Can lead to cirrhosis and liver failure.

● HELLP Syndrome: Is caused by preeclampsia and elevated liver enzyme levels.

So, how do you know if you have liver disease that has been caused by pregnancy? If you are suffering from nausea, vomiting, abdominal pain, and/or jaundice, it could be a sign to get your liver checked out. The sooner the advancement of a potential disease is caught, the more time you will have to get treatment. According to the Medical Science Monitor Journal, “a mortality rate of 0 to 25% has been reported among mothers with pregnancy-related liver diseases” (2). Don’t become a statistic — go and get checked out!

The only way to determine if your pregnancy is causing a progression of liver disease is by receiving a blood test. This is crucial for both mother and child because the outcome of the pregnancy depends entirely on the exact cause of the liver disease (1). 

Risk Factors of Being Pregnant with Liver Disease

What if you already have liver disease yet want to start trying for a baby or are currently expecting? In order to have a safe and smooth pregnancy, take note of the possible risk factors that come along with certain liver diseases:

● Cirrhosis: If you currently have cirrhosis, getting pregnant can be difficult, with the risk of miscarriage being high as well. Since the scarring of your liver is severe, serious complications can occur, such as visceral bleeding due to increased blood pressure (2).  

● Hepatitis B: If you have hepatitis B, you should be screened early during pregnancy, and medical therapy will be necessary (2). There is a high risk for infection in infants, and both mother and child will need to be monitored afterwards in case of a flare-up. 

● Hepatitis C: This virus thankfully does not worsen liver disease or affect pregnancy, but it should still be closely monitored (2). 

● Autoimmune Hepatitis: If you have autoimmune hepatitis, there is a high chance of your pregnancy resulting in cirrhosis (2). Risk factors include low birth rate and health complications for both mother and child.  

Additionally, if you had previously received a liver transplant, fertility in women is usually restored, but there can still be risks or complications like preeclampsia/eclampsia, acute cellular rejection, gestational diabetes, graft loss, and bacterial sepsis (2). Therefore, it is still crucial to follow up with your transplant team both before and after pregnancy.

What You Can Do

Pregnancy can come with a lot more baggage when you are already struggling with liver disease. The best strategy going into any pregnancy with liver disease is constant monitoring, along with managing your condition beforehand. Those who are at risk of developing liver disease need to be especially careful and follow up with their doctor regularly in order to avoid any issues as early as possible (1). When it comes to pregnancy and liver disease, preventive care is your best bet for a smooth delivery!

It’s also important to look after your liver health before pregnancy! Eating a balanced diet, exercising regularly, avoiding contaminated needles or water, and getting vaccinated for hepatitis A and B are all ways to give your liver some love. And don’t forget about taking The Plug daily for long-term liver support!

If you’re ready to bring a bundle of joy into the world, make sure your liver is ready, too. Prepare your entire body for the kicks from those little developing feet, and soon you’ll be tickling them away!

Bibliography

1. Wakim-Fleming J. Liver Disease in Pregnancy [Internet]. Cleveland Clinic. Available from: https://my.clevelandclinic.org/departments/digestive/medical-professionals/hepatology/liver-disease-in-pregnancy#definition-causes-tab 

2. Mikolasevic I, Filipec-Kanizaj T, Jakopcic I, Majurec I, Brncic-Fischer A, Sobocan N, et al. Liver Disease During Pregnancy: A Challenging Clinical Issue. Medical Science Monitor [Internet]. 2018 June 15;24: 4080-4090. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6034557

3. Newby J. Liver Function and Its Connection to Hormone Regulation [Internet]. MI Blue Daily. 2024 Apr 10. Available from: https://www.bcbsm.mibluedaily.com/stories/health-and-wellness/liver-function-and-its-connection-to-hormone-regulation  

4. Baqc Y. The Liver in Normal Pregnancy. Madame Curie Bioscience Database [Internet]. 2000-2013. Available from: https://www.ncbi.nlm.nih.gov/books/NBK6005