Acute fatty liver of pregnancy is rare and life-threatening, associated with accumulation of fetal free fatty acids in the maternal liver due to fetal LCHAD deficiency.

• A. True
• B. False
• C. Only occurs in twin pregnancies
• D. Only causes maternal liver disease without fetal involvement

Answer: (A)

AFLP is a rare, life-threatening pregnancy complication where the mother's liver becomes fatty because of a process tied to the fetus’s ability to metabolize fats. The most well-supported mechanism involves a fetal fatty-acid oxidation defect, most classically LCHAD deficiency. When the fetus cannot properly oxidize long-chain fatty acids, those fats accumulate and are transferred to the maternal circulation via the placenta. The maternal liver then stores these fatty acids, leading to microvesicular steatosis and hepatic dysfunction that can progress to liver failure, coagulopathy, hypoglycemia, and encephalopathy if not managed promptly. Clinically, this presents with nausea, malaise, abdominal pain, jaundice, and abnormal liver tests, and it requires urgent stabilization and delivery.

This statement is correct because AFLP is indeed rare and life-threatening and is associated with fetal fatty-acid oxidation defects like LCHAD deficiency causing the buildup of fetal fatty acids that affect the maternal liver. It is not confined to twin pregnancies, and it involves both maternal and fetal pathology, not maternal disease alone.