Non-alcoholic steatohepatitis in pregnancy: a case report

Abstract

Abstract Background Dyslipidemia and non-alcoholic fatty liver disease are well-known diseases and are part of a very broad spectrum evolving toward non-alcoholic steatohepatitis (NASH). This entity has not been described in pregnant women and could have obstetrical repercussions. Case presentation A 26-year-old woman with 28 + 5 weeks of pregnancy presented with preterm labor. At admission, a significant hepatic cytolysis was detected (AST/ALT 265/485 U/L—GGT/alkaline phosphatase 60/164 U/L). She had normal blood pressure and negative 24-h proteinuria. She did not have intrahepatic cholestasis of pregnancy (bile acid at 7) and also no organic hepatic etiology (negative serologies and imaging). This cytolysis worsened until a more detailed history revealed a potential etiology: a diet very rich in sugars and fatty acids corresponding to a NASH syndrome. Dietary rebalancing improved the cytolysis. Complications such as intrahepatic cholestasis of pregnancy and preterm birth favored by significant dyslipidemia could not be avoided. Conclusions It is important to consider the lipid profile of our patients. This will allow for a more personalized follow-up given the possible obstetrical repercussions that can arise from this pathology. It should also be considered in the differential diagnosis of liver test alterations during pregnancy. A healthy diet seems to help control the disease.