Acute Fatty Liver of Pregnancy (AFLP) is a rare, life-threatening complication that typically emerges in the late third trimester. This serious condition involves the rapid accumulation of fat within the liver cells. The liver’s inability to effectively process fatty acids, often linked to an underlying metabolic deficiency unmasked by pregnancy, leads to acute liver failure. The resulting organ dysfunction quickly becomes a medical emergency for both the mother and the developing fetus. Recognizing this disorder promptly is paramount, as treatment relies on immediate medical intervention to prevent severe maternal and fetal outcomes.
Identifying Symptoms and Diagnostic Confirmation
The initial signs of Acute Fatty Liver of Pregnancy can often be mistaken for common pregnancy discomforts, but worsening symptoms require immediate medical evaluation. Patients frequently report the sudden onset of severe, persistent nausea and vomiting, malaise, or extreme fatigue. Abdominal pain, particularly in the upper right quadrant, is a common complaint signaling potential liver distress. These symptoms usually appear after the 30th week of gestation, though they can manifest earlier or immediately following delivery.
As the condition progresses, a yellowish discoloration of the skin and eyes, known as jaundice, may develop. More concerning signs include confusion, excessive thirst, and headache, suggesting widespread organ involvement. A definitive diagnosis is confirmed not by symptoms alone, but through a specific panel of laboratory tests that reveal the extent of liver damage and systemic failure.
Blood tests look for elevated liver enzymes, such as Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT). A significant finding in AFLP is often dangerously low blood sugar (hypoglycemia), due to the compromised liver’s inability to regulate glucose. Tests also show abnormalities in blood clotting factors (coagulopathy) and evidence of impaired kidney function, such as high creatinine and uric acid levels. These findings allow healthcare providers to confirm the diagnosis and distinguish AFLP from other pregnancy-related liver disorders.
Immediate Acute Medical Management
The most important step in managing Acute Fatty Liver of Pregnancy is the prompt delivery of the fetus. Delivery is the definitive treatment because it removes the underlying hormonal and metabolic stressor—the pregnancy itself—that drives the liver failure. Delaying this intervention increases the risk of severe complications, including maternal death and multi-organ failure.
Before delivery can be safely performed, the immediate focus is on stabilizing the mother’s condition through intensive supportive care, often involving transfer to an Intensive Care Unit (ICU). Intravenous fluids are administered to maintain adequate hydration and circulation. Glucose solutions are continuously infused to correct the severe hypoglycemia characteristic of AFLP.
Correcting the dangerous coagulopathy is a high priority, especially if a surgical delivery is anticipated. Fresh frozen plasma and other blood products are transfused to replenish clotting factors, minimizing the risk of severe hemorrhage. The decision on the mode of delivery is made quickly by a multidisciplinary team, including obstetricians, hepatologists, and critical care specialists, based on the mother’s stability and the fetal condition.
Post-Delivery Recovery and Monitoring
Following delivery, the mother requires intensive monitoring, as AFLP complications can persist or temporarily worsen. Fortunately, removing the pregnancy’s metabolic burden usually leads to rapid improvement in the mother’s clinical condition. The liver begins recovery, though laboratory values may take longer to return to normal.
Continuous monitoring of liver function tests, blood glucose levels, and kidney function is sustained until all values normalize, typically within seven to ten days postpartum. The medical team remains vigilant for potential complications, including acute kidney failure, pancreatitis, and disseminated intravascular coagulation (DIC). Postpartum hemorrhage is also a concern due to the pre-existing coagulopathy.
Monitoring also extends to the newborn, particularly if the delivery was premature due to the mother’s condition. All infants born to mothers with AFLP should be screened for a genetic metabolic disorder called long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency. Identifying this deficiency is important for the infant’s long-term health and for genetic counseling regarding future pregnancies.
Long-Term Lifestyle and Dietary Adjustments
Long-term health management shifts toward preventative measures, especially for those with an underlying metabolic predisposition. Regular follow-up with a gastroenterologist or hepatologist is necessary to ensure liver function tests remain normalized. This professional oversight helps monitor for any residual or recurring liver issues.
Adopting a healthier lifestyle minimizes the overall metabolic strain on the body. Dietary modifications should focus on reducing the intake of processed sugars and saturated fats. A diet rich in whole foods, similar to a Mediterranean-style pattern, supports liver health and helps maintain a healthy weight.
Regular physical activity is also encouraged as a method of weight management and for improving overall metabolic function. For women who plan on future pregnancies, genetic counseling is advised to assess the risk of recurrence and to understand the implications of any identified LCHAD deficiency.