To explore the influencing factors of the complications of pregnant women with acute fatty liver during pregnancy (AFLP). Methods: The clinical data of 153 pregnant women with AFLP admitted to the hospital from January 2020 to October 2023 were collected retrospectively. The basic information, the hematology indexes values and the score of acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) of the women were collected. The women with cesarean section were followed up for 6 months after surgery. Proportional risk model was used to analyze the factors affecting the complications of the pregnant women with AFLP. Receiver operating characteristic (ROC) curve was drawn to evaluate the efficacy of these influencing factors for predicting the complications of the women with AFLP. Results: The incidence of the postoperative complications of the women with AFLP was 23.5% (36/153). Multiariable regression analysis showed that the time from AFLP onset to visiting the hospital, the total bilirubin value, and the increased prothrombin time and APACHE Ⅱ score of the women were all the independent factors affecting their complications. ROC curve analysis showed that the time of AFLP onset to visiting the hospital (AUC=0.712), the total bilirubin value (AUC=0.741), the prothrombin time (AUC=0.734), the APACHEⅡ score (AUC=0.758), and the combination of the time from AFLP onset to visiting the hospital, the total bilirubin value and the increase of prothrombin time and APACHE Ⅱ score (AUC=0.906) of the women with AFLP had certain efficacy for predicting their complications. Conclusion: The longer time from AFLP onset to visiting the hospital, the high value of total bilirubin, and the increased prothrombin time and APACHE Ⅱ score of the women with AFLP are all the independent influencing factors of their complications, and all of these four influencing factors have certain efficacy for predicting the complications of the pregnant women with AFLP.