Clinical Updates in Women’s Health Care Summary: Liver Disease: Reproductive Considerations

ABSTRACT All women are at risk of acute and chronic liver diseases. Of particular importance are those diseases that exclusively affect pregnant women and have adverse effects on maternal, fetal, or neonatal outcomes. Acute viral hepatitis is an important cause of liver disease in pregnant women, and hepatitis E infection is associated with substantial mortality. An increasing number of women have chronic liver diseases caused by viral hepatitis, alcoholic liver disease and nonalcoholic fatty liver disease, autoimmune liver diseases, and genetic liver diseases. The presence of chronic liver diseases or cirrhosis in pregnant or nonpregnant women requires alterations in gynecologic care, including contraception, pregnancy planning, cervical cancer screening, human papillomavirus vaccination, and postmenopausal hormone therapy. Women who have had liver and other solid organ transplantation require gynecologic care tailored to their immunosuppressed status. Collaboration between obstetrician–gynecologists and hepatologists is essential to provide optimal care to women with acute or chronic liver diseases. Timely referral for evaluation for liver transplantation is mandatory for all women with acute liver failure.