Pregnancy outcomes of patients with acute fatty liver of pregnancy: a case control study

Abstract

Background: Limited data exists regarding the pregnancy and infant outcomes of Acute Fatty Liver of Pregnancy (AFLP). Methods: Retrospectively collected mothers with AFLP and mothers without AFLP in our center from 1/2008 to 6/ 2018. The primary assessment was to analyze and compare the frequency of negative maternal and fetal outcomes. The secondary assessment was to investigate the role of intrauterine balloon tamponade in reducing negative maternal outcomes. Results: Compared to 220 matched mothers, 55 AFLP mothers were younger (P < 0.001), with fewer pregnancies (P = 0.033), complicated with more pregnancy induced hypertension (P < 0.001), twins(P = 0.002), fetal growth restriction (P = 0.044) and male fetus (P < 0.001). 3 (5.5%) of AFLP patients were diagnosed in the postpartum period. Mean gestational week of AFLP diagnosis was 35.25 ± 5.80 weeks. Jaundice (89.1%), nausea or vomiting (58.2%), anorexia (49.1%), fatigue (45.5%) and polydipsia (30.9%) were the main prodromal symptoms. The median duration from diagnosis to delivery was 1.55 ± 4.62 days and 75% (39/52) pregnancy were terminated the pregnancy at the day of diagnosis. 78.8% (41/52) patients received cesarean section, 53.6% (22/41) of which received preventive plasma transfusion before surgery and no one received artificial liver support during the treatment. In comparison, higher frequency of 16 maternal complications, severe negative outcomes (27.3% vs. 0.9%) and newborn asphyxia (24.6% vs.0.9%) were observed in AFLP population. 3 mothers (mortality rates: 5.5%) died of multiple organ system failure and 6 fetus/infants (death rates: 9.8%) died of distress. When compared to those without negative outcomes, patients with negative fetal outcomes were younger (P = 0.042), had more singleton rates (p = 0.041), increased mean value of ALT(P = 0.011) and T-Bilirubin (P = 0.014), decreased prothrombin activity (P = 0.011). Although no statistical significance for the small sample size, there were less refractory postpartum

Maternal and Neonatal Outcomes in Pregnant Women With SARS-CoV-2 Infection Complicated by Hepatic Dysfunction

“…Postpartum hemorrhage, the need for blood transfusions, complications like sepsis and multiorgan failure, and mortality were more often seen in the group with hepatic dysfunction. A higher frequency of adverse maternal and fetal outcomes was observed in pregnant women with liver dysfunction [ 28 ]. Furthermore, deranged liver function was associated with severe COVID-19 with the extent of derangement being proportional to the severity of COVID-19 [ 29 ].…”

A Rare Disease Presenting Postpartum: Acute Fatty Liver of Pregnancy

“…AFLP is a rare and serious liver pregnancy-related disease with an incidence of 1 per 6500 to 20 000 pregnancies [ 4 ]. Publications in the 1980s suggested mortality rates as high as 70%; more recent studies, suggest lower mortality rates: approximately 20% in some centers in low-income countries or even less than 10% in high-income countries.…”

Pregnancy-Associated Liver Diseases

“…156 The maternal characteristics most frequently associated with AFLP include first pregnancy, multifetal pregnancy, male fetus, and low body mass index. 157,158 The association of AFLP with preeclampsia and HELLP may reflect the risk associated with long-chain fatty acid deficiency (LCHAD) heterozygous mothers with LCHAD homozygous fetuses, where severe preeclampsia and HELLP may increase substrates of fatty acid oxidation above the already elevated levels in pregnant women without preeclampsia and HELLP.…”

“…Most present in the third trimester, but AFLP has been diagnosed as early as 23 weeks and 5% to 25% of cases are diagnosed postnatally. 157,158,173 AFLP is an obstetric emergency. Maternal and infant mortality parallel liver disease severity, and survival is influenced by the timeliness of the diagnosis.…”