Liver Conditions Specific to Pregnancy: Optimizing Management and Outcomes.

Pregnancy is accompanied by complex physiological adaptations that influence hepatic metabolism, bile transport, coagulation, and immune tolerance, which may precipitate the development of pregnancy-specific liver disorders. Gestational liver disease comprises a distinct group of conditions such as hyperemesis gravidarum (HG), intrahepatic cholestasis of pregnancy (ICP), acute fatty liver of pregnancy (AFLP), and the spectrum of preeclampsia that includes hepatic involvement and Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. Although heterogeneous in presentation and pathophysiology, these disorders share the potential for significant maternal and fetal morbidity and mortality. Early recognition and hepatology-guided interpretation of abnormal liver biochemistry during pregnancy are critical to differentiate gestational liver disease from underlying chronic liver disease and to identify conditions that require urgent intervention. Management of gestational liver disease requires coordinated, multidisciplinary care focused on maternal stabilization, appropriate disease-specific therapy, and carefully timed delivery according to both maternal and fetal risk. Treatment strategies range from supportive and nutritional management for HG, biochemical and symptom control with ursodeoxycholic acid for ICP, and urgent delivery and intensive supportive care for AFLP to delivery with antihypertensive and anticonvulsant therapy for hypertensive disorders and HELLP syndrome. Although each condition poses unique diagnostic and therapeutic challenges, complications associated with gestational liver disease in pregnancy may be reduced through proactive management and multidisciplinary involvement. This review summarizes current evidence on the pathophysiology, diagnostic evaluation, management strategies, and pregnancy outcomes associated with pregnancy-specific liver disorders.