Pregnancy is often described as a magical journey—but sometimes, it can come with rare and dangerous twists. One such twist is a serious condition known as Acute Fatty Liver of Pregnancy (AFLP), which can strike suddenly during the third trimester. Though rare, this condition is considered an obstetric emergency, carrying significant risks for both the mother and the unborn child.
With only about 5 cases reported in every 100,000 pregnancies, AFLP doesn’t happen often—but when it does, it requires immediate medical attention. Doctors stress that early detection and swift treatment are essential to prevent life-threatening complications.
So, what exactly is Acute Fatty Liver of Pregnancy, why does it happen, and how can it be treated? Let’s break it down.
WHAT IS ACUTE FATTY LIVER OF PREGNANCY (AFLP)?
AFLP is a serious liver disorder that typically develops in the third trimester of pregnancy, when fat starts building up in the liver and impairs its ability to function properly. The liver, which plays a crucial role in filtering toxins and producing essential proteins, essentially becomes overwhelmed and inflamed.
Unlike more common pregnancy complications, AFLP isn’t something that can be predicted or prevented. According to Dr. Vidyashri Kamath, a specialist at KMC Hospital in Mangalore, the condition is often linked to mitochondrial dysfunction and genetic factors, particularly an inherited deficiency in an enzyme called long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD). This enzyme is essential for breaking down fatty acids, and when it doesn’t work properly, fat begins to accumulate in the liver cells.
WHO IS AT RISK?
While any pregnant woman can theoretically develop AFLP, doctors have identified certain risk factors that make some women more vulnerable. These include:
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First-time pregnancies (nulliparous women)
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Carrying twins or a male fetus
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Having a low body mass index (BMI)
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A history of preeclampsia or gestational diabetes
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Intrahepatic cholestasis of pregnancy (another liver-related complication)
However, it’s important to note that AFLP can still occur even in women without these risk factors. That’s why awareness of symptoms is so crucial.
SYMPTOMS TO WATCH OUT FOR
The early signs of AFLP can be easy to miss, as they often mimic common pregnancy complaints. According to Dr. Spurthy G Janney from Manipal Hospital in Whitefield, women in the late stages of pregnancy may experience:
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Persistent nausea and vomiting
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Loss of appetite
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Extreme fatigue
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Upper abdominal pain, especially on the right side
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Jaundice (yellowing of the skin and eyes)
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Unusual thirst
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Mental confusion or changes in consciousness in severe cases
As the disease progresses, symptoms can escalate rapidly, making timely diagnosis all the more critical.
HOW IS AFLP DIAGNOSED?
There’s no single test that can confirm AFLP, which makes diagnosis a bit of a challenge. Doctors rely on a combination of clinical symptoms and lab tests to reach a conclusion.
Tests typically include:
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Liver function tests
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Blood sugar levels
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Coagulation profile (to check how well blood is clotting)
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Ultrasound imaging of the abdomen to examine the liver and kidneys
In some rare cases where the diagnosis remains unclear, a liver biopsy may be performed, though this is not common due to the risk involved.
TREATMENT: TIME IS CRUCIAL
The good news? AFLP is treatable—but the only definitive solution is delivering the baby as soon as possible. Once the baby and placenta are delivered, the harmful processes affecting the liver often come to a halt, and the mother begins to recover.
“Delivery is the cure,” says Dr. Kamath, who emphasizes that quick and efficient action is essential. Most cases require caesarean section delivery after the mother is stabilized. This often takes place in a high-level hospital equipped to handle critical care, given the risks of organ dysfunction, infection, and bleeding disorders.
Post-delivery, liver function typically begins to normalize within 7 to 10 days. Supportive care, such as IV fluids, medications to stabilize blood pressure, and monitoring of kidney and liver function, plays a key role in recovery.
OUTCOMES AND RECOVERY
Thanks to advances in early detection and medical care, maternal mortality due to AFLP has significantly decreased and is now under 5%. Most mothers recover completely with the right treatment, and babies can also be delivered safely if the condition is managed in time.
Still, the situation can be very serious if left undiagnosed or untreated. That’s why any pregnant woman experiencing unusual symptoms—especially in the third trimester—should seek medical care immediately.
FINAL THOUGHTS: LISTEN TO YOUR BODY
Pregnancy is filled with changes, but when something doesn’t feel right, it’s important not to brush it off. AFLP is a rare but serious condition that can escalate quickly. Being aware of your body and seeking care early can make all the difference.
While AFLP can’t be prevented or predicted, timely diagnosis and quick delivery can save lives. If you’re pregnant and experiencing symptoms like persistent vomiting, jaundice, or unusual pain in your upper abdomen, consult your healthcare provider without delay.
Because when it comes to pregnancy complications like AFLP, every hour counts.
