Evaluation of changes in liver function test in first, second and third trimester of normal pregnancy

Abstract

Background: Understanding of physiological adaptations of normal pregnancy remains a major goal of obstetrics, and without such knowledge, it is almost impossible to understand disease processes that can threaten women during pregnancy. Aim of this study is to evaluate changes in serum liver function tests in normal pregnant women in first, second and third trimester. Methods: A hospital based cross sectional in vitro study conducted at Civil Hospital, Ahmedabad (India). A study consists of 150 pregnant women and 50 matched control. Among the 150 pregnant women, 50 were in first trimester, 50 were in second trimester and 50 were in third trimester. Serum sample was taken and assessed for routine liver function tests. Results: Serum total and direct bilirubin concentrations were significantly lower in second and third trimester. Serum ALT and AST activity was slightly but significantly increased in third trimester. Serum ALP activity was significantly higher in second and third trimester. ALP activity increases as pregnancy advances. Serum GGT values were significantly lowers in third trimester. No significant change in serum total proteins concentration, but serum albumin concentration was significantly lower and serum globulin concentration was significantly higher in all three trimester. Serum albumin/globulin ratio was significantly reduced in second and third trimester. Conclusion: Such changes in in liver function tests during normal pregnancy can be misinterpreted as pathological and can also unmask or worsen preexisting disease. So the identification and understanding of these physiological changes in pregnancy is important for the diagnosis of liver diseases during pregnancy.

A cross sectional study of liver function tests in normal pregnancy during third trimester: a treasure from the past

“…13,14 Gohel MG et al observed that serum total and direct bilirubin concentrations were significantly lower in second and third trimester. 15 However ACG 2016 guideline support that there is no significant rise in serum belirubin levels in pregnancy. 9 SGOT levels were normal in as many as 88 % of our study population (mean±SD; 20±15.2).…”

Liver Function Tests in Normal Pregnant Women

“…This increase is mainly due to the production of placental isoenzyme rather than elevation of hepatic isoenzyme. Additionally, there is an increased production of the bone isoenzyme with gestational age as a result of fetal bone development [16]. The diversity of the sources of serum ALP shows that it is not a reliable and/ or a suitable test for liver disease during late pregnancy [3].…”

“…Albumin is a globular protein, formally called human serum albumin. It is produced by the liver and comprises about half of the total protein in blood [16,18,19]. Albumin is negatively charged at physiologic pH; therefore binds negatively charged cations (e.g., Ca 2+ , Na + , K + ), some hormones, conjugated bilirubin and some medications.…”

“…During the first trimester, conjugated bilirubin concentration in pregnant women is the same as in the non-pregnant women; however, it decreases in the second and third trimesters. Hemodilution with pregnancy age partly explains the corresponding decrease in bilirubin concentration [10,16,[32][33][34].…”

“…High unconjugated bilirubin suggests hemolysis or genetic disease such as Gilbert's and Crigler-Najjar syndromes in which there are problems with bilirubin conjugation. Meanwhile, high conjugated bilirubin can be seen in early/mild biliary system disease and in genetic disease such as Dubin-Johnson and Rotor syndromes [10,16].…”