Typically occurring during the third trimester, acute fatty liver of pregnancy is a potentially life-threatening condition caused by the sudden deposition of fat within the liver cells
Acute fatty liver of pregnancy (AFLP) is a severe complication that typically occurs in the third trimester of pregnancy. While it is rare, experts list this condition as one of the most serious pregnancy-related health emergencies.
Dr Chetan Ramesh Kalal, DM hepatologist and program director, adult hepatology and transplant medicine center for liver, pancreas, and intestine transplantation, Nanavati Max Super Specialty Hospital, Mumbai, explains that AFLP is the sudden deposition of fat within liver cells, leading to liver dysfunction and ultimately liver failure. The condition, also known as acute yellow atrophy of the liver, can be life-threatening to both the mother and the fetus.
What causes AFLP?
The illness is brought on by issues with the metabolism of fatty acids during pregnancy, according to Professor Dr. Neelamekam Thoppa Kapali, HOD, gastroenterology and liver transplant surgeon, Fortis Malar, Chennai. It is still unknown what the specific cause of AFLP is. However, some new study suggests that it might be caused by mitochondrial malfunction during fatty acid breakdown. Dr. Kalal makes the observation that the absence of one of the enzymes necessary for fatty acid breakdown would result in the accumulation of extra fat. He continues by stating that the manifestation of this ailment may also be influenced by the hormonal balance during pregnancy.
“Estrogen and progesterone hormones experience significant variations, which can have an impact on a variety of metabolic functions, including fat metabolism. According to Dr. Kalal, they may cause fat accumulation and an abrupt deterioration of liver function.
Around 5% fat should normally be present in the liver. However, it can go as high as 13 to 19 percent in females with AFLP. The primary causes of liver failure are this excessive fat buildup and ammonia produced by hepatocytes (liver cells engaged in lipid breakdown).
Precautions
According to Dr. Kapali, a woman’s body undergoes significant changes just by being pregnant. As a result, it’s critical to reduce alcohol intake, manage weight, and maintain a nutritious diet. To prevent severe liver problems, the person should be more cautious, keep an eye on themselves during pregnancy, and maintain a healthy liver.
Dr. Kalal further emphasizes that routine prenatal care is the most crucial intervention. The doctor can keep track of the mother’s and fetus’s health by doing routine checkups. Avoiding recreational drug usage and substance misuse is also very important. Early detection, rapid medical intervention, stress management, and sufficient sleep can all significantly impact outcomes.
Does AFLP affect the fetus or baby?
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Dr. Kapali explains that the effects of AFLP on the developing fetus can vary depending on which month of the third trimester it happens in. Premature birth brought on by earlier occurrences, as in the seventh month, might cause the newborn infant to severely underdevelop.
Dr. Kalal further emphasizes that the fetus should normally be checked for hypoglycemia (low blood sugar). The fetus is vulnerable to low blood sugar and seizures because of a deficiency in fatty acid metabolism, he claims. We must thus keep an eye on them and be very attentive.
Treatment for acute fatty liver of pregnancy
Early detection and prompt medical intervention are crucial in ADLP. Dr Kalal explains that once the person is diagnosed, there should be continuous monitoring of both the mother and the fetus.
The only treatment is urgent childbirth. “AFLP resolves after childbirth, and the mother’s health returns to normal,” explains Dr Kapali. He adds that delivery is crucial because liver dysfunction can lead to respiratory and kidney problems, which can be fatal for both the mother and baby.
“Most of the cases can be handled with adequate medical care, early diagnosis, and prompt delivery,” shares Dr Kalal. But he adds that in some cases if acute fatty liver of pregnancy is diagnosed too late and liver failure occurs, the pregnant woman might require a liver transplant.
Takeaways
- Acute fatty liver of pregnancy is a rare but severe condition. It is usually seen in the third trimester.
- Jaundice is a common symptom of the condition. Once diagnosed, both the mother and the fetus should be continuously monitored.
- It could be fatal to the mother and the baby, and immediate childbirth is the only treatment.
- It is important to maintain a healthy lifestyle, especially during pregnancy, and keep the liver healthy to avoid complications.
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