ABSTRACT

Most pregnant women are young and healthy, and liver disease is uncommon in this patient population. Also, the presence of liver disease must not be confused with some of the physiologic changes of pregnancy that mimic features commonly associated with liver dysfunction, including spider nevi and palmar erythema in 50% of pregnant women, increased alkaline phosphatase levels from placental production, and decreased serum concentrations of albumin and hemoglobin with expanded blood volume (Table 1). Changes in bilirubin and aminotransferase concentrations, hepatomegaly, splenomegaly, liver tenderness, or bruits do not occur in normal pregnancy, and the clinical finding of jaundice is always abnormal. Abnormalities in liver enzyme levels occur in 5% of pregnancies and jaundice in 0.1%, with a clinical significance that is highly variable from a self-limiting to a rapidly fatal condition.