Causes of Liver Failure in Pregnancy: What You Need to Know

When liver failure in pregnancy, a serious condition where the liver stops working properly during gestation. Also known as pregnancy-related liver disease, it affects fewer than 1 in 10,000 women but can be life-threatening if not caught early. Most cases happen in the third trimester, and they’re not caused by alcohol or hepatitis like typical liver damage—they’re tied directly to the changes your body goes through while growing a baby.

The two biggest culprits are acute fatty liver of pregnancy, a rare but severe condition where fat builds up in liver cells and HELLP syndrome, a complication of preeclampsia that breaks down red blood cells, lowers platelets, and raises liver enzymes. Both can start with vague symptoms—nausea, upper right belly pain, fatigue—that many mistake for normal pregnancy discomfort. But if you’re feeling unusually sick after 28 weeks, especially with vomiting or blurry vision, don’t wait. These conditions can spiral fast.

Some medications can make things worse. For example, roflumilast, a COPD drug sometimes used off-label, carries warnings for liver stress and is generally avoided in pregnancy. Even common pain relievers like high-dose NSAIDs can add strain. That’s why knowing your drug history matters—something we cover in detail in posts about drug safety during pregnancy.

What you’ll find in these articles

Below are real, practical guides from doctors and pharmacists who’ve seen these cases. You’ll read about how HELLP syndrome is diagnosed with blood tests, why acute fatty liver of pregnancy often means early delivery, and which drugs—like certain beta-blockers or antidepressants—might need switching during pregnancy. You’ll also find clear comparisons of medications that are safer, like which diabetes pills carry less risk, or how birth control hormones differ from pregnancy hormones in their impact on the liver. This isn’t theory—it’s what works in real clinics, for real moms.