Liver disease in pregnancy

Liver disease in pregnancy is becoming increasingly common, and this includes both pre-existing liver disease and pregnancy-specific liver disease. Pre-existing liver disease, such as metabolic dysfunction–associated steatotic liver disease (MASLD), is associated with increased maternal and fetal risk. Preconception counselling and optimization of disease status pre-pregnancy is therefore essential. The anticipated physiologic and biochemical changes in pregnancy that affect liver function and enzymes impact what lab values are considered “normal” and what conditions are higher risk in pregnancy. A trimester-specific approach to elevated liver enzymes can be used to guide the work-up and differential diagnosis of a patient who presents with abnormal liver enzymes. Early identification and diagnosis of liver disease in pregnancy with delivery planning that includes a multidisciplinary team is crucial for improving maternal and fetal outcomes.