Transient diabetes insipidus and acute fatty liver of pregnancy

ABSTRACT Objective To review the association of transient diabetes insipidus and acute fatty liver of pregnancy. Design A retrospective study. Setting Six women presenting with polyuria and polydipsia in the third trimester or in the immediate postpartum period, referred over a two and a half year period; five out of six were primigravida. All had raised liver transaminases and biopsy‐proven acute fatty liver of pregnancy. Four out of six also had pre‐eclampsia. Subjects Tertiary referral centre. Main outcome measures There were no maternal deaths and only one fetal death. Desamino‐cys‐1‐D‐arg‐8‐vasopressin administration produced a reduction in urine output in all five women to whom it was administered. In all cases symptoms had resolved by the end of the fourth postpartum week. Three of the women have had subsequent pregnancies uncomplicated by either transient diabetes insipidus or acute fatty liver of pregnancy. Conclusions The association of transient diabetes insipidus and acute fatty liver of pregnancy appears more common than previously recognised. Both may be part of the spectrum of pre‐eclampsia.