Metabolic and Synthetic Dysfunction in Acute Fatty Liver of Pregnancy: Reappraising the Swansea Criteria—A Narrative Review
- 1“Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
Abstract
Acute fatty liver of pregnancy (AFLP) is a rare microvesicular steatotic liver disease of late gestation, linked to impaired mitochondrial fatty acid β-oxidation, in which management centres on recognition and delivery before overt hepatic and multiorgan failure has developed. The Swansea criteria, which require six or more of fourteen features in the absence of an alternative explanation, define AFLP in guidelines and in most published cohorts. This narrative review examines how the criteria behave across the course of the illness and which markers might signal the disease earlier. The criteria are frequently fulfilled once AFLP is clinically established, but their accuracy against an independent reference standard derives from one small, high-prevalence biopsy series, and their specificity against haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome and other causes of acute liver failure appears limited. Because several criteria index established organ failure, the threshold may remain unmet earlier in the illness, a hypothesis consistent with limited retrospective evidence; to our knowledge, no study has evaluated the criteria prospectively at initial presentation. We relate each criterion to hepatic energy failure and appraise candidate early markers, including coagulation indices, antithrombin, conjugated hyperbilirubinaemia, hypocholesterolaemia, soluble fms-like tyrosine kinase-1 and metabolite-level signals of fatty acid oxidation failure; none has a validated early diagnostic threshold. We outline a conceptual, hypothesis-generating framework for prospective research that would complement, not replace, the Swansea case definition.
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BibTeX
@article{condriuc2026metabolic,
title = {{Metabolic and Synthetic Dysfunction in Acute Fatty Liver of Pregnancy: Reappraising the Swansea Criteria—A Narrative Review}},
author = {Iustina Petra Solomon Condriuc and Razvan Popovici and Eric Oliviu Cosovanu and Raluca Anamaria Mogos and Raluca Haba and Vasile Adrian Sescu and Raluca Stefana Stan and Simona Juliette Mogos and Catalin Mihai Buzduga and Alexandru Carauleanu},
journal = {Metabolites},
year = {2026},
month = oct,
doi = {10.3390/metabo16100799},
url = {https://www.mdpi.com/2218-1989/16/10/799},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Metabolic and Synthetic Dysfunction in Acute Fatty Liver of Pregnancy: Reappraising the Swansea Criteria—A Narrative Review
AU - Iustina Petra Solomon Condriuc
AU - Razvan Popovici
AU - Eric Oliviu Cosovanu
AU - Raluca Anamaria Mogos
AU - Raluca Haba
AU - Vasile Adrian Sescu
AU - Raluca Stefana Stan
AU - Simona Juliette Mogos
AU - Catalin Mihai Buzduga
AU - Alexandru Carauleanu
PY - 2026
DA - 2026/10/21
JO - Metabolites
DO - 10.3390/metabo16100799
UR - https://www.mdpi.com/2218-1989/16/10/799
AB - Acute fatty liver of pregnancy (AFLP) is a rare microvesicular steatotic liver disease of late gestation, linked to impaired mitochondrial fatty acid β-oxidation, in which management centres on recognition and delivery before overt hepatic and multiorgan failure has developed. The Swansea criteria, which require six or more of fourteen features in the absence of an alternative explanation, define AFLP in guidelines and in most published cohorts. This narrative review examines how the criteria behave across the course of the illness and which markers might signal the disease earlier. The criteria are frequently fulfilled once AFLP is clinically established, but their accuracy against an independent reference standard derives from one small, high-prevalence biopsy series, and their specificity against haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome and other causes of acute liver failure appears limited. Because several criteria index established organ failure, the threshold may remain unmet earlier in the illness, a hypothesis consistent with limited retrospective evidence; to our knowledge, no study has evaluated the criteria prospectively at initial presentation. We relate each criterion to hepatic energy failure and appraise candidate early markers, including coagulation indices, antithrombin, conjugated hyperbilirubinaemia, hypocholesterolaemia, soluble fms-like tyrosine kinase-1 and metabolite-level signals of fatty acid oxidation failure; none has a validated early diagnostic threshold. We outline a conceptual, hypothesis-generating framework for prospective research that would complement, not replace, the Swansea case definition.
SN - 2218-1989
ER -