Pregnancy can trigger a variety of liver diseases.(Obstetrics)

CAMBRIDGE, MD. -- The liver is a dynamic organ during pregnancy, and standard physiologic changes may mimic pregnancy-induced hepatic disease.

The clinical challenge of distinguishing the normal from abnormal liver during pregnancy was addressed by Ayman Koteish, M.D., of Johns Hopkins University, Baltimore.

For example, a clinician may detect spider angiomata and palmar erythema, which are associated with liver diseases, during a physical examination of a pregnant woman, but these signs are to be expected in pregnancy and do not indicate liver disease. These two signs are thought to result from a high-estrogen state, Dr. Koteish said.

On the other hand, a palpable liver in pregnancy, especially in late pregnancy, is not to be ignored, he said at a hepatobiliary update sponsored by the university.

Laboratory results during pregnancy commonly show decreases in albumin of 1 g/dL. Alkaline phosphatase may rise to levels two to four times normal, and increases in total bile acids to 11 [micro]mol/L or less are common. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels may rise a little, but stay within the normal range.

Hyperemesis gravidarum

The hallmark nausea and vomiting that characterize this condition in 2% of pregnant women may lead to dehydration and malnutrition. Some women may develop a transient hyperthyroidism that eventually gets better as hyperemesis gravidarum resolves itself.