Alexandra Frolkis

Pregnancy is accompanied by complex physiological adaptations that influence hepatic metabolism, bile transport, coagulation, and immune tolerance, which may precipitate the development of pregnancy-specific liver disorders. Gestational liver disease comprises a distinct group of conditions such as hyperemesis gravidarum (HG), intrahepatic cholestasis of pregnancy (ICP), acute fatty liver of pregnancy (AFLP), and the spectrum of preeclampsia that includes hepatic involvement and Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. Although heterogeneous in presentation and pathophysiology, these disorders share the potential for significant maternal and fetal morbidity and mortality. Early recognition and hepatology-guided interpretation of abnormal liver biochemistry during pregnancy are critical to differentiate gestational liver disease from underlying chronic liver disease and to identify conditions that require urgent intervention. Management of gestational liver disease requires coordinated, multidisciplinary care focused on maternal stabilization, appropriate disease-specific therapy, and carefully timed delivery according to both maternal and fetal risk. Treatment strategies range from supportive and nutritional management for HG, biochemical and symptom control with ursodeoxycholic acid for ICP, and urgent delivery and intensive supportive care for AFLP to delivery with antihypertensive and anticonvulsant therapy for hypertensive disorders and HELLP syndrome. Although each condition poses unique diagnostic and therapeutic challenges, complications associated with gestational liver disease in pregnancy may be reduced through proactive management and multidisciplinary involvement. This review summarizes current evidence on the pathophysiology, diagnostic evaluation, management strategies, and pregnancy outcomes associated with pregnancy-specific liver disorders. Cite this article as: Frolkis A, Ergenc I, Heneghan MA. Liver conditions specific to pregnancy: optimizing management and outcomes. Turk J Gastroenterol. Published online April 8, 2026. doi: 10.5152/tjg.2026.26024.

Preexisting liver disease, particularly the presence of cirrhosis and portal hypertension (PHT), presents a significant challenge during gestation, necessitating close collaboration between obstetric and hepatology/gastroenterology teams. Women with underlying liver conditions face an increased likelihood of adverse maternal and fetal outcomes. Proactive identification and management of the potential risks associated with pregnancy in this patient group is therefore crucial. While the desire to start a family is deeply personal, each pregnancy carries unique risks requiring careful consideration. Although no single recommendation can comprehensively address all forms of liver disease, pregnancy in women with underlying hepatic conditions can be both safe and achievable when managed througha multidisciplinary team approach, involving the mother and her partner from the preconception stage through to the postpartum period. This review summarizes the current evidence regarding the risks and management strategies for pregnancy complicated by preexisting liver disease, including cirrhosis and PHT, steatotic liver disease, viral hepatitis, autoimmune liver disease, and liver transplant recipients. Cite this article as: I E, A F, MA H. Preexisting liver disease and pregnancy: optimizing care to optimize outcomes. Turk J Gastroenterol. Published online January 2, 2026. doi: 10.5152/tjg.2026.25753.