Acute Fatty Liver of Pregnancy (AFLP) is a rare and life-threatening metabolic disorder of pregnancy. It presents in the third trimester with lack of energy, nausea, vomiting, drowsiness and confusion. Blood tests show evidence of synthetic liver failure and acute kidney injury. Sub-acute placental failure often results in fetal demise.
Non-specific signs and symptoms at presentation inevitably delay the diagnosis of AFLP and cause confusion with other disorders of pregnancy. We identified novel presenting signs and symptoms in 33 women with AFLP, which would be useful in discriminating AFLP from HELLP syndrome, thrombotic thrombocytopaenic purprura (TTP) and haemolytic uraemic syndrome (HUS).
AFLP has been associated with rare disorders of mitochondrial fatty acid metabolism. The most widely-cited defect is a heterozygous deficiency of long chain hydroxyacyl dehydrogenase (LCHAD) in the mother and homozygous defect in the fetus. However, this defect is absent in most cases of AFLP. Novel defects in the central control of maternal appetite during the third trimester combined with a gestational defect in maternal fat metabolism will be proposed as an additional pathophysiological pathway to AFLP.