The liver metabolism of pregnant women differs from that of the rest of the population and has some hemodynamic alterations, but the overall differences are not significant. Certain hepatic biochemical parameters are clearly different from the general population, such as low serum albumin, increased alkaline phosphatase, and increased total bile acids. Liver damage is more common in pregnant women, with varying degrees of severity. The top five pregnancy-related deaths are in the order of obstetric hemorrhage, gestational hypertensive syndrome, heart disease in pregnancy, amniotic fluid embolism, and puerperal infection, and do not include liver disease in pregnancy. However, some liver diseases during pregnancy are acute, such as acute gestational fatty liver and severe hepatitis that occurs during pregnancy. Fortunately, the incidence of these severe liver diseases is low and the success rate of resuscitation is relatively high. There are two major categories of liver disease during pregnancy, namely pregnancy-specific liver disease and non-pregnancy-specific liver disease. Pregnancy-specific liver disease refers to liver damage that occurs only during pregnancy, while non-pregnancy-specific liver disease refers to a category of liver disease unrelated to pregnancy itself, including acute and chronic liver disease that existed prior to pregnancy and acute liver disease that occurs after pregnancy, with acute viral hepatitis and drug-related liver injury being more common in the latter. Pregnancy-specific liver disease may manifest as single organ damage to the liver or may be combined with severe damage to other organs. The main ones include the following: acute pregnancy vomiting, intrahepatic cholestasis of pregnancy, pre-eclampsia, hemolysis-hepatic enzyme elevation-thrombocytopenia syndrome, acute gestational fatty liver, and primary liver pregnancy. The pathogenesis of this group of liver diseases is complex, but there are more than a few patterns to follow, such as the possible association of different liver diseases with the gestation period, the number of pregnancies, singleton or twin pregnancies, and the disappearance of liver disease after termination of pregnancy. However, certain liver diseases need to be differentiated from non-pregnancy-specific liver diseases, for example, the pathogenesis and clinical manifestations of acute gestational fatty liver are very similar to liver failure due to various liver diseases (fulminant hepatitis, severe hepatitis), and their differential diagnosis depends on an adequate history of hepatitis and ancillary investigations before pregnancy. A suggestive point is that acute gestational fatty liver disease recovers more quickly after termination of pregnancy, whereas liver failure due to other liver diseases recovers more slowly. There is a wide range of diseases with liver disease in the non-pregnancy special period. Broadly speaking, all kinds of liver diseases can be found in pregnant women, however, due to age and eugenics considerations, the “spectrum of liver diseases” differs somewhat from that of non-pregnant women, such as acute viral hepatitis, drug-related hepatitis, alcoholic hepatitis, and cirrhosis (including compensated and decompensated cirrhosis), but chronic hepatitis, especially chronic viral hepatitis, is relatively uncommon. hepatitis, especially chronic viral hepatitis, is more common and is the most common type of liver disease specific to non-pregnancy. In our country, chronic hepatitis B has a high prevalence rate, so the clinical problems of women with chronic hepatitis B in pregnancy are particularly striking. Chronic hepatitis C is also a more common group of viral hepatitis, and the negative impact on pregnancy is also evident. The etiologic diagnosis of these two types of viral hepatitis is not complicated and difficult, either based on immunological principles of antigenic antibody diagnosis or genetic diagnosis of virus-specific nucleic acids, which can quickly obtain evidence of relevant viral infection, and the quantitative diagnostic techniques of viral genes (hepatitis B virus DNA and hepatitis C virus RNA) are so well established that they have become not only a routine means of qualitative diagnosis, but also a means of observing It is also an important tool for observing antiviral efficacy and predicting disease prognosis. For women of childbearing age, routine screening for hepatitis B virus and hepatitis C virus markers must be performed prior to pregnancy. The diagnostic concept of viral hepatitis should also extend to the evaluation of the disease and its duration, such as liver biochemical markers and liver imaging, which should be obtained before pregnancy and monitored during pregnancy. In women of childbearing age, the issue of antiviral therapy for chronic viral hepatitis has been controversial, and there is a gradual convergence of opinion in favor of implementing blockade before or after pregnancy. It should be noted that women with chronic hepatitis B who are not effectively treated with antiviral therapy before or during pregnancy still have about 5% of fetuses with intrauterine hepatitis B virus infection even if the newborn is born with hepatitis B vaccine and hepatitis B immunoglobulin; and women with chronic hepatitis C who are not given effective antiviral therapy before pregnancy have a probability of vertical transmission of hepatitis C from mother to child The likelihood of vertical transmission of hepatitis C from mother to child is between 6% and 30% if women with chronic hepatitis C are not given effective antiviral treatment before pregnancy. In addition, for chronic viral hepatitis with active disease, during pregnancy, the increased burden on the liver of the pregnant woman may induce an aggravation of the liver disease or even liver failure. Therefore, for women with chronic viral hepatitis, it is important for physicians to adequately communicate with their patients preparing for pregnancy before they become pregnant, informing them of the relationship between liver damage, vertical transmission of the virus from mother to child, and the possible adverse effects of antiviral drugs on the fetus. The Clinical Guidelines for the Management of Chronic Hepatitis B Viral Infection, developed by the European Association of Liver Diseases (EASL) in 2012, specifically address the following principles for the management of antiviral therapy in women of childbearing age with chronic hepatitis B: (1) Family planning should be communicated prior to antiviral therapy for women of childbearing age; (2) Interferon is contraindicated during pregnancy; (3) The U.S. Food and Drug Administration (FDA) (3) The FDA classifies entecavir, lamivudine, and adefovir as class C drugs for pregnancy, while telbivudine and tenofovir are class B drugs for pregnancy and can be used in pregnant women, but the risks should be communicated prior to use; (4) Limited antiviral therapy should be administered prior to pregnancy for those with progressive liver fibrosis and cirrhosis; (5) Viral load greater than 106-7 IU/mL, even if the newborn is given hepatitis B vaccine and Hepatitis B-specific immunoglobulin, the risk of vertical transmission is greater than 10%, and the use of nucleoside analogues should be advised to improve the vaccine blockade effect. The results of Chinese researchers (Xu Weimin et al. and Korea Rong et al.) showed that the use of lamivudine and telbivudine in the second trimester increased the blockade effect and therefore recommended the use of pregnancy class B drugs. Most hepatitis C is chronic and is transmitted mainly by the blood route. As mentioned earlier, hepatitis C has a high risk of mother-to-child transmission and therefore, women of childbearing age should implement antiviral therapy prior to pregnancy. Unlike chronic hepatitis B, hepatitis C is a “curable” viral hepatitis and can be cured in about 80% of patients with hepatitis C using the so-called “standard therapy” of interferon in combination with ribavirin. Although there is insufficient evidence-based evidence, it can be assumed that because of the relatively young age of pregnant women and the relatively short duration of hepatitis C virus infection, antiviral therapy may be more effective and aggressive interferon-based standard therapy before pregnancy is recommended. Cirrhosis is not an absolute contraindication to pregnancy, but the risks of pregnancy are obvious, among them the greatly increased likelihood of inducing ruptured variceal bleeding in patients with severe combined esophagogastric fundic varices due to increased portal pressure after pregnancy. Therefore, conception should be avoided in female patients in whom the cause cannot be removed and in whom cirrhosis is still in a progressive stage. Conception after bypass or vascular ligation in such patients has been reported to reduce the incidence of bleeding after pregnancy. Patients with chronic hepatitis B cirrhosis or chronic hepatitis C cirrhosis, when the disease is in the compensated stage, can both be treated with antiviral drugs, and it is even possible to reverse cirrhosis after long-term treatment, but there are few studies reported on conception in women with cirrhosis, and information has yet to be accumulated. In patients with decompensated cirrhosis, although a few successful pregnancies and births have been reported, these patients assume great risk when conceiving and should be actively discouraged from conceiving. Autoimmune hepatitis, a unique group of immune-compromising diseases more commonly seen in women of childbearing age (young), is not a contraindication to conception, but may make conception difficult due to active hepatitis, severe liver disease and failure to ovulate, which can be treated with adrenal glucocorticoids or immunosuppressive agents to gain fertility. A few patients have been reported to achieve remission of the disease after pregnancy, but the disease can reignite after delivery. It has also been reported that the incidence of fetal malformations in pregnant women treated with low-dose immunosuppressive agents such as azathioprine is no higher than in normal pregnant women, but there is a risk of increased obstetric complications in such patients. Therefore, pregnant women with autoimmune hepatitis should be given more attention or targeted prenatal screening or monitoring and given appropriate hepatoprotective therapy. Primary biliary cirrhosis (PBC) is also an autoimmune liver disease. However, for a long time, the term “cirrhosis” has misled not only patients but also medical personnel, especially causing a great psychological burden to patients and, obviously, more psychological stress to women of childbearing age or pregnant women. In fact, early PBC has no histological changes of cirrhosis at all. It was named “cirrhosis” in the early years because of the lack of knowledge about the disease, and it was not until the stage of cirrhosis developed that the diagnosis was confirmed. It is now believed that PBC can be divided into four pathologic stages, with only patients with stage IV pathology having cirrhosis, and patients with stages I-III showing mainly chronic non-suppurative inflammation and injury of small and medium-sized bile ducts. In April 2014, Professor Ma Xiong from the Institute of Gastroenterology, Renji Hospital, Shanghai Jiaotong University School of Medicine, advocated for the first time the abolition of the term “primary biliary cirrhosis” at the annual European Liver Conference, suggesting a name change to “primary biliary cirrhosis”. to “primary biliary cholangitis or primary biliary cholestasis”. Ursodeoxycholic acid can effectively control the progression of PBC and is currently the drug of choice for the treatment of PBC, and no significant adverse effects have been observed in non-pregnant women. Pregnant women with viral hepatitis A do not have an increased incidence of severe liver disease, but with viral hepatitis A in late pregnancy, the infant is at increased risk of preterm delivery. The disease occurs most often in young people, and women of childbearing age are a susceptible group. A hepatitis A vaccine is available to help prevent it, and for women of childbearing age who are negative for hepatitis A virus, they should receive the hepatitis A vaccine before becoming pregnant. Viral hepatitis E is a type of acute viral hepatitis that has a high prevalence in China and is mainly transmitted through water and food, but can be transmitted to the fetus in utero through the placenta in pregnant women. Although the disease is also acute hepatitis, but more serious than hepatitis A, the prognosis is worse than hepatitis A. The death rate after the disease is between 0.5% and 4%. The mortality rate of pregnant women infected with hepatitis E virus is as high as 20%! The risk of contracting hepatitis E virus in late pregnancy is higher than in the general population. The clinical presentation and course of fulminant hepatitis due to hepatitis E is very similar to that of AFLP, and the differentiation depends on the pathogenic diagnosis. Obstetricians in clinical practice need to be well aware of hepatitis E co-infection in pregnant women. A vaccine for hepatitis E virus has been successfully developed but is not yet widely available for vaccination. Hepatitis E vaccination may be considered for women of childbearing age. The reason for the low probability of drug-induced hepatitis in pregnant women is that pregnant women are less likely to take medications due to concerns about the effects of medications on the embryo and fetus. However, as long as medications are taken, there is a risk of developing drug-induced liver injury. Severe fatal drug-related liver disease has been reported in HIV-infected women who received anti-retroviral therapy after pregnancy. In addition, there is information that the incidence of adverse reactions to drugs is not increased in pregnant women. In earlier years, it was reported that 1300 pregnant women taking the anti-tuberculosis drug isoniazid did not develop drug-related liver injury. Women with hereditary and metabolic liver disease have an increased risk of fetal growth retardation and preeclampsia after pregnancy. Liver disease of pregnancy is a common condition in pregnant women and may present as a transient transaminase elevation in mild cases or can be fatal in severe cases. Clinically, there are significant differences in the pathogenesis, clinical presentation, management and prognosis between liver diseases specific to pregnancy and those not specific to pregnancy. The diagnosis and treatment of such liver diseases involve multidisciplinary fields such as obstetrics and gynecology, infection and hepatology, etc. Strengthening interdisciplinary cooperation can help improve clinical diagnosis and treatment, reduce the occurrence of severe liver diseases in pregnant women and decrease the mortality rate of patients with severe liver diseases.