Endocrine Abstracts

Liver disorders can be precipitated by pregnancy, e.g. severe pre-eclampsia with HELLP (haemolysis, elevated liver enzymes and low platelets) syndrome, intrahepatic cholestasis of pregnancy (ICP) and acute fatty liver of pregnancy. Many women with liver disease need to be looked after by specialist physicians with an understanding of the impact of pregnancy on the disorder, the implication of some medications for the fetus, and also the potential risk of adverse pregnancy outcomes. Pre-pregnancy counselling and referral to specialist clinics will maximise the likelihood of good maternal and fetal health. Hepatic steatosis is increasingly reported in women of reproductive age. There is currently limited understanding of the prevalence and outcomes of steatotic liver disease in pregnancy. A US study reported that the proportion of pregnant women with metabolic dysfunction-associated steatotic liver disease (MASLD) tripled from 2007 to 2015. Pregnant women with MASLD had higher rates of maternal cardiometabolic disorders including gestational diabetes mellitus (GDM) and hypertension. They also had higher rates of pregnancy complications including preterm birth and postpartum haemorrhage. Furthermore, north American data report that MASLD is the commonest underlying cause of cirrhosis in pregnant women. This represents a considerable change from previous studies of cirrhosis in pregnancy where the principal underlying causes of cirrhosis were viral and autoimmune hepatitis. Cirrhosis remains associated with increased risk of serious maternal morbidity and mortality, principally from gastrointestinal haemorrhage. It is also complicated by maternal cholestasis, hypertensive disease, preterm birth and prolonged admission to the neonatal unit. Some gestational liver diseases are associated with subsequent maternal and offspring risk of hepatobiliary disease, including steatosis, MASLD and cirrhosis. Pregnancy represents a time when women and children at risk of fatty liver and associated metabolic disorders can be identified and interventions can be initiated to improve subsequent health outcomes.