Diagnostic Approach to Elevated Liver Function Tests during Pregnancy: A Pragmatic Narrative Review

Area of Science:

• Obstetrics and Gynecology
• Hepatology
• Maternal-Fetal Medicine

Background:

• Liver disease in pregnancy poses significant risks to maternal and fetal health.
• Physiological changes during pregnancy can mimic or exacerbate liver conditions.
• Distinguishing between chronic, acute, and pregnancy-specific liver diseases is crucial.

Purpose of the Study:

• To provide a pragmatic overview of the diagnostic work-up for elevated liver enzymes in pregnancy.
• To summarize current management strategies for liver disorders during gestation.
• To highlight the importance of accurate diagnosis for obstetric care and long-term health.

Main Methods:

• Narrative review of existing literature.
• Focus on diagnostic approaches and clinical management.
• Synthesis of information on pregnancy-specific liver diseases.

Main Results:

• Pregnancy-specific liver conditions include hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, and acute fatty liver of pregnancy.
• Elevated liver enzymes in pregnancy share symptoms and lab findings, necessitating careful differentiation.
• Up to 40% of elevated liver enzyme causes in pregnancy remain unclear, with limited data on outcomes.

Conclusions:

• Accurate diagnosis of liver disease in pregnancy is essential for guiding obstetric management and reducing complications.
• Further research is needed to understand the causes and implications of unexplained elevated liver enzymes during pregnancy.
• Effective management strategies are key to improving maternal and fetal/neonatal outcomes.