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©2013 UpToDate ® Print Email American College of Gastroenterology Guidelines: Liver disease in the pregnant patient Use of gestational age of the pregnancy is the best guide to the differential diagnosis of liver disease in the pregnant woman Hyperemesis gravidarum should be considered in the differential diagnosis of abnormal liver tests presenting in the first trimester Cholestasis of pregnancy is common, and should be considered in the differential diagnosis of abnormal liver tests presenting initially in the second trimester. Affected pregnancies are at increased risk for prematurity and stillbirth, and early delivery should be considered when possible HELLP (hemolysis, elevated liver tests, low platelets) syndrome and acute fatty liver of pregnancy should be considered in the differential diagnosis of abnormal liver tests in the second half of pregnancy, usually in the third trimester Patients with acute fatty liver of pregnancy have true hepatic dysfunction, and may, or may not, have signs of pre-eclampsia and HELLP syndrome Consider viral or drug-induced hepatitis, gallstone disease, or malignancy in the differential diagnosis of abnormal liver tests in any of the trimesters of pregnancy Chronic hepatitis B or C poses a risk of transmission to the offspring Data from: Riely CA. Liver disease in the pregnant patient. Am J Gastroenterol 1999; 94:1728.