Liver diseases in pregnancy - Liver diseases induced by pregnancy - part 1

First trimester:
Hyperemesis gravidarum:
Although this is not primarily a liver disorder, it affects the liver in up to 50% of patients.
Factors thought to favor an increased risk for hyperemesis gravidarum include obesity, nulliparity, and twin gestation.
The origin of the liver disease associated with hyperemesis gravidarum is unclear.
Not all affected patients have liver disease.
Therefore, the vomiting does not appear to be secondary to the liver involvement.
Starvation alone does not seem to be an adequate explanation for the liver dysfunction, particularly in as much as biopsy in affected patients fails to show the fatty infiltration typical of starvation.
Affected patients present in the first trimester, usually by weeks 10 to 12.
They have persistent nausea and vomiting and experience weight loss, often of significant amounts.
 They also have ptyalism (excessive spitting).
Laboratory testing demonstrates abnormal liver values in up to 50% of affected patients.
 The most sensitive test is the ALT, which may rise as high as 1000 U. Severely affected patients also have elevations in bilirubin.