During pregnancy, there are some changes in the liver that occur physiologically, such as alternations in blood flow and hepatic cholesterol synthesis and secretion. However, liver diseases specific to pregnancy can occur, and the differential diagnosis from diseases coincidental with pregnancy or pre-existing liver disease is mandatory for proper therapeutic algorithms. Hyperemesis gravidarum develops in 1- 20/1000 pregnancies. Intrahepatic cholestasis of pregnancy is the second most common cause of jaundice in pregnancy, mutations in the MDR3 biliary canalicular protein have been found, and ursodeoxycholic acid is considered the most effective therapeutic option. Acute fatty liver of pregnancy (AFLP) occurs in about 1 /14000 pregnancies and in some cases is associated with homozygous long-chain 3 hydroxyacyl
coenzyme A dehydrogenase deficiency in the fetus with a heterozygote mother. AFLP has a wide range of severity and a large degree of overlap in clinical and laboratory findings with HELLP (haemolysis, hepatic enzyme elevation, and low platelets) syndrome and pre-eclampsia/eclampsia. The latter is the major cause of maternal death in developed countries associated with complications, such as hepatic rupture and early delivery is considered the key component for reducing mortality.