Table 4. Pregnancy-related clinical manifestations with shared features of liver disease.

Clinical sign/symptom	Potential etiologies/differential diagnostic considerations195
Telangiectasias & Spider nevi	Normal due to presence of increased estrogen
Pruritus	Dermatologic:196,197 Atopic eruption of pregnancy (including eczema in pregnancy, prurigo of pregnancy, and pruritic folliculitis of pregnancy). Typically manifests early in pregnancy, <3rd trimester with trunk and limb skin involvement. Polymorphic eruption of pregnancy (also known as pruritic urticarial papules and plaques of pregnancy); pemphigoid gestationis. Typically manifests in 3rd trimester with predominant abdominal skin involvement. Pemphigoid gestationis may be associated with small for date infant, while the other dermatologic conditions are usually without significant maternal or fetal risks. Gastrointestinal: Intrahepatic cholestasis of pregnancy. Generally presents as sudden onset of generalized pruritus during late 2nd or 3rd trimester. Typically without rash but may have secondary skin lesions such as linear skin excoriations and excoriated papules resulting from scratching. Associated with elevated total serum bile acid levels and fetal risks including still births, prematurity, and fetal distress. Endocrine: Sex-hormone abundance during pregnancy
Fatigue	May have multifactorial etiology including: Endocrine: Thyroid disorder, gestational diabetes Hematologic: Anemia Cardiovascular: Hypotension (i.e. inferior vena cava compression by gravid uterus); hypovolemia/dehydration; hypertension (i.e. preeclampsia); cardiomyopathy Musculoskeletal: Physical and mechanical stress of gravid uterus. Lumbar hyperextension resulting in low back pain; joint laxity resulting from pregnancy hormones (progesterone/relaxin) and leading to pelvic pain (pubic symphysis change/diastasis); excess weight-bearing and bone alterations leading to joint pain (low back, knees, sacroiliac joints) Psychiatric: Disturbed sleep, depression Other: Medication-induced effects
Abdominal pain	Gastrointestinal: Gallstone disease, cholangitis, gastroesophageal reflux disease, constipation, irritable bowel syndrome, appendicitis, diverticulitis, intra-abdominal hemorrhage Obstetric/Gynecologic: Ectopic pregnancy (early), spontaneous or threatened abortion, labor (preterm or term), leiomyomas, endometriosis, ovarian cyst, pelvic inflammatory disease/salpingitis, uterine rupture Genitourinary: Urinary tract infection, cystitis, pyelonephritis, nephrolithiasis
Jaundice	Gastrointestinal: Obstructive gallstone disease/cholangitis; drug-induced cholestasis Obstetric: HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) Hematologic: Hemolysis