Epidemiologic Trends in Acute, Chronic, and Pregnancy-Specific Liver Diseases in Pregnancy

INTRODUCTION: Chronic liver diseases (CLDs) and cirrhosis are rising in reproductive-aged female patients, primarily driven by increasing alcohol-related liver disease and metabolic dysfunction-associated steatotic liver disease (MASLD). However, contemporary data on acute, chronic, and pregnancy-specific liver diseases remain limited. METHODS: This 10-year retrospective study at a tertiary center included all pregnancies from January 1, 2014, to December 31, 2023. Liver conditions-categorized as acute, chronic, and pregnancy-specific-were identified by diagnosis codes. Sociodemographic and pregnancy-related data were collected from electronic medical records. Group comparisons were performed using the χ 2 and Student t tests. Temporal trends were assessed through the Cochrane-Armitage test. RESULTS: Among 51,708 pregnancies, 1,429 (2.8%) were affected by 1 or more liver condition: 85 (4.8%) with acute, 913 (51.8%) with CLD including 77 (4.4%) with cirrhosis, and 784 (44.5%) with pregnancy-specific liver diseases (e.g., intrahepatic cholestasis of pregnancy; acute fatty liver of pregnancy; hemolysis, elevated liver enzymes, and low platelets syndrome; and preeclampsia with liver involvement). Prevalent CLD in pregnancy increased over time, with a shift from chronic viral hepatitis to MASLD ( P values <0.01). Pregnancy-specific liver conditions remained stable over time, though occurred more commonly in those with concurrent CLD (intrahepatic cholestasis of pregnancy 3.2% vs 0.6%; preeclampsia 11.3% vs 6.3%; hemolysis, elevated liver enzymes, and low platelets syndrome 0.6% vs 0.2%; and acute fatty liver of pregnancy 0.2% vs 0.0%; all P < 0.01). DISCUSSION: In this large epidemiologic study, we observed a 2.5-fold rise in CLD in pregnancy over the past 10 years, largely driven by the rising prevalence of MASLD, and declining prevalence of chronic viral hepatitis. Pregnancy-specific liver conditions were also significantly more common in those with CLD. Findings underscore the relevance of preconception counseling by hepatology providers and the importance of early obstetric collaboration to optimize outcomes for the growing number of pregnant women with preexisting liver disease.