Pregnancy fat liver

The Pregnancy fat liver is a serious complication that can be potentially life-threatening for both mother and child. What causes fat to be stored in the liver cells of the pregnant woman is currently not clearly understood. Treatment consists in ending the pregnancy as soon as possible. In most cases, the liver regenerates completely in the weeks after birth.

What is a pregnancy fat liver?

In the Pregnancy fat liver it is a rare complication that leads to severe liver dysfunction in the expectant mother. There is excessive storage of fat in the cells of the liver (hepatocytes), which means that the liver can only carry out its various tasks to a limited extent.

Typically, symptoms do not manifest until the last trimester and can be life-threatening. The pregnancy fat liver is basically reversible; all symptoms resolve after delivery. The incidence of this pregnancy complication is estimated to be between 1: 7000 and 1: 16000.

Exact numbers are not available due to the rarity of this hepatological disease. The diagnosis is a great challenge for the treating physicians. Doctors from different disciplines such as hepatology, neonatology, surgery and gynecology must work together to rule out other possible diseases.

causes

The exact causes for the development of a pregnancy fat liver are still unclear. A genetic predisposition may play a role in the development. This complication occurs more frequently in some families, which suggests that hereditary factors are involved.

In addition, taking certain drugs, such as anti-epileptic drugs, can increase the risk of the disease. In exceptional cases, the disease could be linked to the use of antibiotics during pregnancy. In this hepatic disease, the breakdown of fatty acids, the so-called beta-oxidation, is disturbed in the cells of the liver.

Fatty acids cannot be broken down and metabolized properly, which is why fat accumulates in the hepatocytes. If this process is not stopped, more and more fat will build up in the liver until liver failure occurs. The exact pathogenesis is unknown. In rare cases, an enzyme defect in the fetus plays a role in the development of pregnancy fat.

Symptoms, ailments & signs

An acute pregnancy fat liver mostly only occurs around the 35th week of pregnancy and is associated with many unspecific symptoms. Affected women often suffer from pain in the upper abdomen, loss of appetite, fatigue, headache, nausea and vomiting.

Persistent back pain can also occur. The symptoms usually start easily and increase in intensity over time. At an advanced stage, jaundice occurs, when the skin, especially the conjunctiva of the eyes, turns yellow. Affected women usually have a very fast heartbeat. The liver is responsible for the production of the blood's coagulation factors.

If the liver function is impaired, blood clotting problems can occur. Affected women have punctiform bleeding into the skin. Mucous membranes are often affected by this small bleeding. There is an increased tendency to bleed during childbirth.

In severe cases, a pregnancy fat liver leads to bleeding into the digestive tract, kidney failure and hepatic encephalopathy with coma. This can lead to the death of the expectant mother and the unborn child. Such severe courses are rare, as the pregnancy is usually terminated before the pregnant woman's condition worsens.

Diagnosis & course of disease

Due to the unspecific symptoms, the diagnosis of pregnancy fat is complex and time-consuming. If your pregnancy is advanced and you have symptoms of liver problems, a blood test will be done first. An ultrasound examination is not always meaningful.

If there is no coagulation disorder, the diagnosis can be made by a liver biopsy followed by a histological examination. The pregnancy fat liver is a serious illness which, if left untreated, can lead to the death of the mother and the child. With rapid therapy, however, the prognosis can be regarded as positive.

The complications associated with it are just as rare as the pregnancy fat liver itself. However, if they do occur, they can have serious effects.

Complications

Possible sequelae of pregnancy fat only show up in the last part of pregnancy. On average, this is the 35th week of pregnancy. The women affected often suffer from a loss of appetite, tiredness, nausea, vomiting, headaches, back pain and painful discomfort in the upper abdomen. Other effects include a yellow discoloration of the skin and the conjunctiva and an accelerated heartbeat.

If the pregnancy fat liver is intense, there is a risk of complications such as kidney failure (kidney weakness) and bleeding within the gastrointestinal region. In extreme cases, the pregnant woman can fall into a coma. Because liver and blood coagulation functions are also affected by the pregnancy fat, blood coagulation disorders sometimes occur.

They are noticeable in punctiform small bleeding on the skin and mucous membrane. Major bleeding is possible during labor. In addition, extensive bruises can form on the liver. Due to the associated increase in pressure, there is a risk of liver rupture.

The effects of acute pregnancy fat also include serious metabolic disorders such as lower levels of sodium and potassium in the blood, hypoglycaemia or the breakdown of protein. In some cases, an acute pancreatitis also develops. In the worst case, these serious complications can even result in the death of the pregnant woman or her child.

When should you go to the doctor?

A pregnancy fat liver must always be treated immediately by a doctor. It is a serious disease that, if left untreated, can lead to serious complications and symptoms. The earlier the pregnancy fat is recognized and treated, the better the further course. A doctor should be consulted if the person concerned suffers from severe pain in the abdomen or from severe loss of appetite.

This can also lead to significant tiredness as well as nausea or severe headaches. Furthermore, frequent vomiting can also indicate the pregnancy fat liver and should be examined by a doctor if it persists and does not go away on its own. In many cases there is discomfort to the skin, jaundice or severe pain in the back. A doctor should always be consulted with these complaints as well.

A gynecologist or general practitioner is usually consulted in the case of pregnancy fat. Further treatment then takes place in a hospital. In most cases, if diagnosed early, the disease can be treated relatively well so that the life expectancy of the mother and child is not affected.

Treatment & Therapy

The only causal therapy for pregnancy fat is the induction of childbirth. Depending on the situation and health of the pregnant woman, medication can be used to induce labor or a caesarean section. The child is usually born as soon as possible in order to prevent acute liver failure in the pregnant woman.

Since it is a serious complication, affected women are mainly treated in the intensive care unit. This is necessary, among other things, because the state of health can deteriorate very quickly and requires immediate action. A blood transfusion may be necessary.

The administration of coagulation factors is especially important in advanced fatty liver disease in order to counteract the tendency to bleed. After delivery, the newborn is examined for enzyme defects and, if necessary, further treatment is initiated. If the delivery was initiated early enough, the disease will for the most part quickly regress and the pregnant woman can leave the hospital a few weeks after the birth.

In severe cases, there may be no improvement in liver function postpartum. If there is acute liver failure, only a liver transplant can save the woman's life. Affected women must be informed about the risk of recurrence if they become pregnant again after they have recovered.

prevention

It is currently not known exactly what leads to the development of a pregnancy fat liver. Targeted prevention is therefore not possible. In known cases of hepatological complications during pregnancy in the family, this should be discussed with the attending gynecologist during a preventive examination.

Under certain circumstances, close check-ups are necessary in the last trimester of pregnancy. In addition, the use of medication during pregnancy should definitely be discussed with a specialist in gynecology. In general, the condition is so rare that most pregnant women shouldn't worry.

Aftercare

Since pregnancy fat is a disease that occurs temporarily in connection with pregnancy, it is entirely possible that it will resolve on its own after delivery. The body can adjust to normal metabolism again.

Follow-up care varies greatly depending on the course of the disease. Check-ups and regular blood tests are required to determine the liver values. The course and healing can be seen very well. The sonographic examination can also provide indications of the healing process.

However, it is to be expected that the body will need some time even after pregnancy to regulate the processes and break down the fat stored in the liver. In difficult cases, a consistent change in lifestyle may be necessary.This relates in particular to diet and the increase in physical activity.

A healthy lifestyle should be continued even after the pregnancy fat has healed. The attending physician can provide appropriate tips and help for this as part of the follow-up examinations. Complicated courses with significant weight gain and persistent fatty liver disease should always be observed and treated by an experienced gastroenterologist, as this can lead to recurring symptoms.

You can do that yourself

This disease, which is life-threatening for women and their unborn baby, rarely occurs. However, it forces the doctors to act: the child must be carried to term as soon as possible so that it does not develop into severe courses with serious complications. The affected mothers would therefore do well to agree to an early induction of the birth.

All of the symptoms that a pregnancy fat liver brings with it subside in the vast majority of cases after the child is carried to term and are therefore reversible. Nevertheless, it is advisable to continue to pay attention to your own liver health even after the hospital stay. The liver is a detoxification organ. In order not to burden them unnecessarily, as few toxins as possible should be absorbed. Alcohol, nicotine, too fatty and too sweet food are just as taboo as indiscriminately reaching for medication. Over-the-counter medicines can also put a strain on the liver.

Naturopaths recommend drinking a lot of green tea for liver detoxification because it should be able to dissolve and remove fat in the liver. Artichokes are also used as a liver protection agent. Detoxification measures also relieve the liver. Anything that causes sweat is recommended, such as Saunas, steam baths or sports. Food also has a detoxifying effect. Turmeric, a curry spice, is said to promote detoxification. But asparagus and fruit rich in water also help flush out unnecessary toxins from the body.