What is Acute Fatty Liver of Pregnancy (AFLP)

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When Uncommon Becomes Urgent

She was 36 weeks pregnant and visibly uncomfortable—far more than what you’d expect for someone that far along. Her husband half-joked that she seemed to have turned yellow overnight. When I checked her blood pressure, it was through the roof, and her skin carried a yellowish tint no expecting parent wants to see. That moment, I knew this wasn’t the usual end-of-pregnancy exhaustion. It was the start of something much rarer: what is acute fatty liver of pregnancy—a condition that can escalate rapidly, threatening both mother and baby.

What is Acute Fatty Liver of Pregnancy and How Does It Present?

Acute fatty liver of pregnancy (AFLP) is a rare but serious complication that can develop during the third trimester or immediately after delivery. It’s caused by an abnormal accumulation of fat in the liver, impairing the organ's ability to function. Unlike other liver conditions that build slowly over time, AFLP can come on suddenly and escalate quickly, leading to life-threatening outcomes if left untreated.

It’s essential to catch AFLP early because its symptoms can easily be confused with those of more common pregnancy-related issues, such as preeclampsia or cholestasis. Understanding what is acute fatty liver of pregnancy could make the difference between a manageable outcome and a medical emergency.

Symptoms That Demand Immediate Attention

AFLP doesn’t always arrive with flashing warning signs, but when symptoms appear, they tend to cluster and progress fast. Initial signs might include nausea, vomiting, or general fatigue—easy to overlook in the final weeks of pregnancy. But when jaundice (yellowing of the skin or eyes), confusion, or severe abdominal pain join the mix, it’s time to act quickly.

One of the trickier aspects of AFLP is its overlap with conditions like HELLP syndrome, which involves liver dysfunction and low platelet counts. The key is in recognizing patterns: nausea that doesn’t improve, dark urine signaling poor liver function, and confusion indicating brain involvement are all red flags.

What Causes Acute Fatty Liver of Pregnancy?

Though the exact mechanisms behind AFLP aren’t fully understood, there’s a clear connection to genetic mutations affecting how the body metabolizes fatty acids. In many cases, the fetus may carry a genetic deficiency in an enzyme responsible for breaking down fats. This, in turn, causes fat to build up in the mother’s liver. It’s as if both bodies are operating on crossed wires—what’s meant to nourish one life suddenly becomes a hazard for two.

Research also suggests that women carrying multiples (twins or more) and those with pre-existing liver conditions are at higher risk. While AFLP is not caused by anything the mother does, it often feels random, striking without warning in otherwise healthy pregnancies.

Diagnosing and Managing AFLP: Quick Decisions Matter

When a patient presents with symptoms suggesting acute fatty liver of pregnancy, time is of the essence. Blood tests showing high liver enzymes, low blood sugar, and clotting abnormalities are telltale signs. An ultrasound of the liver may help rule out other causes, though a definitive diagnosis often comes from piecing together symptoms, bloodwork, and imaging results.

Once the diagnosis is made, the goal is simple: deliver the baby as soon as safely possible. In most cases, symptoms improve rapidly after delivery, allowing the liver to recover. But because AFLP affects more than just the liver—it can lead to kidney failure, blood clotting disorders, and encephalopathy—intensive monitoring is essential.

What is Acute Fatty Liver of Pregnancy: Long-Term Outcomes

While most women recover fully after AFLP, the condition can leave both physical and emotional scars. The abrupt nature of the condition and the rapid need for delivery can feel overwhelming. Some women may also develop post-traumatic stress symptoms after facing a life-threatening complication.

The good news is that liver function typically returns to normal once the baby is born. However, women who experience AFLP are often advised to avoid future pregnancies or at least undergo genetic counseling, as there’s a risk of recurrence.

Staying Aware: Prevention Might Not Be Possible, but Vigilance Helps

Unfortunately, there’s no surefire way to prevent AFLP. But regular prenatal checkups and open communication with healthcare providers play a significant role in early detection. If you feel "off" in any way during your third trimester, it’s essential to speak up—even if the symptoms seem minor. It’s better to investigate early than to wait for a crisis.

Knowing what is acute fatty liver of pregnancy isn’t just about learning medical terms—it’s about empowering expecting mothers and their families to recognize the signs and advocate for quick intervention. With timely care, both mother and child can emerge healthy, ready to begin the next chapter.

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