Comprehensive guideline for managing liver disorders in pregnancy

FIGO Maternal and Newborn Health Division has published comprehensive guidance for managing both pre-existing and pregnancy-specific liver conditions in the International Journal of Gynecology & Obstetrics. 
 
The guidelines address a growing concern in maternal health, as experts note the rising prevalence of women entering pregnancy with liver disorders or developing them during gestation. Both scenarios are associated with increased maternal and fetal morbidity and mortality. 

The document divides liver diseases in pregnancy into two main categories: gestational disorders like intrahepatic cholestasis of pregnancy (ICP) and acute fatty liver disease of pregnancy (AFLP) and pre-existing conditions including viral hepatitis, cirrhosis and post-transplant management. 

Key recommendations include: 

• weekly monitoring of serum bile acids after 32 weeks for women with ICP
• early multidisciplinary team involvement for women with AFLP
• pre-pregnancy screening for varices in women with cirrhosis
• one-year delay in pregnancy after liver transplantation. 

Liver disease is a common problem affecting women in pregnancy across the globe. Optimal management helps maximise outcomes for both mother and baby. This comprehensive FIGO guidance on liver disease and pregnancy informs healthcare professionals in all world regions on how best to care for these pregnancies. This guidance will prove invaluable in many maternity settings.

Fionnuala McAuliffe, corresponding author and Division Director Elect of the FIGO Maternal and Newborn Health Division 

Healthcare providers are encouraged to implement pre-pregnancy counselling for women with liver conditions and to develop multidisciplinary teams for managing these complex cases during pregnancy, delivery, and postpartum. 

The complete guidelines are available via the International Journal of Gynecology & Obstetrics.