Extreme Elevation of Alkaline Phosphatase in a Pregnancy Complicated by Gestational Diabetes and Infant with Neonatal Alloimmune Thrombocytopenia

Lozo, Svjetlana; Atabeygi, Amir; Healey, M. F.

doi:10.1155/2016/4896487

Cited by 10 publications

(8 citation statements)

References 8 publications

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“…A case control study by Rajagambeeram et al further supported this finding and showed that total serum ALP and placental (heat stable) ALP were significantly elevated in women with hypertensive disorders of pregnancy versus controls [ 11 ]. Other cases reported associations with preterm delivery [ 8 , 14 ], preterm premature rupture of membranes [ 15 ], gestational diabetes [ 14 , 16 , 17 ], and intrauterine growth restriction [ 8 ]. One case report interestingly noted thrombocytopenia in the mother with extremely elevated placental isoenzymes, and upon further investigation was found to have several relatives with elevated baseline ALP suggesting a possible genetic link [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

A Case of Markedly Elevated Isolated Alkaline Phosphatase in the Third Trimester of Pregnancy

Connolly

Grubman

Al-Ibraheemi

et al. 2022

Case Reports in Obstetrics and Gynecology

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Background. Alkaline phosphatase (ALP) is an enzyme produced by the liver, small intestine, bone, and kidneys as well as the placenta during pregnancy. ALP levels may increase up to twice the normal limit during pregnancy secondary to placental release and fetal bone growth. Rare case reports of extremely elevated levels of ALP during pregnancy have demonstrated possible association with adverse pregnancy outcomes. Case. The patient is a 36-year-old G2P1001 who was found to have extremely elevated ALP levels during pregnancy after presenting with bilateral lower leg swelling and rash after receiving the Pfizer COVID-19 vaccine. She subsequently developed intrahepatic cholestasis of pregnancy and preeclampsia. ALP peaked at 2,601 U/L immediately prior to delivery at 36 weeks 1 day. She was followed postpartum, and her ALP levels had nearly normalized by 15 weeks postpartum. Conclusion. Our case demonstrates a rare report of an extremely elevated level of ALP in the setting of multiple adverse pregnancy outcomes, including preterm delivery, preeclampsia without severe features, and intrahepatic cholestasis of pregnancy.

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Section: Discussionmentioning

confidence: 99%

A Case of Markedly Elevated Isolated Alkaline Phosphatase in the Third Trimester of Pregnancy

Connolly

Grubman

Al-Ibraheemi

et al. 2022

Case Reports in Obstetrics and Gynecology

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“…As stated earlier, previous studies tried to understand the mechanism behind this abnormal elevation, which is not fully understood. It was suggested a correlation between ALP elevation and several perinatal complications such as preterm delivery [ 3 ], gestational diabetes [ 5 ], large for gestational age fetuses [ 6 ], and intrauterine growth restriction [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although there are currently few reports describing abnormally high serum ALP in pregnancy, some studies have shown that this enzyme could be an obstetric and perinatal marker associated with preterm delivery [3], hypertensive disorders [4], gestational diabetes [5], large for gestational age fetuses [6], and intrauterine growth restriction [7]. The exact mechanism of this association remains unknown, but it is hypothesized it may be the result of placental insufficiency [3].…”

Section: Introductionmentioning

confidence: 99%

Incidental Finding of Extreme Elevation of Serum Alkaline Phosphatase in Pregnancy

Ferro¹,

Marques²,

Paixão

et al. 2021

Cureus

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Increased levels of alkaline phosphatase (ALP) should alert us to changes in the liver, kidney, bone and malignancy. However, there is a physiological increase in pregnancy up to twice the upper limit. There has been a paucity of cases reporting extreme elevations of ALP in pregnancy. This is a case of an incidental pregnancy finding of a 24-fold increase in ALP in the third trimester (2877 U/L). The patient was kept under surveillance and ALP levels were monitored during the postpartum period.Literature suggests a correlation between ALP elevation and several perinatal complications, proposing it could represent an important tool in monitoring high-risk pregnancies and underlying placental damage. We report a case with no perinatal complications and normal labor at term, with a placenta showing lesions of chronic villitis. We should not rely exclusively on an isolated, marked rise in ALP to dictate the approach in the absence of other fetomaternal considerations.

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“…It is almost three decades since the publication of Brock,9 Best10 and Meyer’s4 work on maternal serum ALP and its association with placental-mediated fetal problems. Little has appeared in the interim apart from sporadic and isolated case reports 6–8 11…”

Section: Discussionmentioning

confidence: 99%

Does an abnormally elevated maternal alkaline phosphatase pose problems for the fetus?

McErlean

King

2019

BMJ Case Rep

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We report a potential association between an abnormally raised pregnancy level of alkaline phosphatase (ALP) and intrauterine growth restriction (IUGR). There are few reports of women with abnormally high ALP during pregnancy. However, there is work to suggest an association with placental insufficiency, low birth weight and preterm delivery. In conjunction with a rising ALP, fetal IUGR and intermittent absence of umbilical artery end diastolic flow had evolved. A greatly elevated ALP may be a marker for placental insufficiency and IUGR.

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Extreme Elevation of Alkaline Phosphatase in a Pregnancy Complicated by Gestational Diabetes and Infant with Neonatal Alloimmune Thrombocytopenia

Cited by 10 publications

References 8 publications

A Case of Markedly Elevated Isolated Alkaline Phosphatase in the Third Trimester of Pregnancy

A Case of Markedly Elevated Isolated Alkaline Phosphatase in the Third Trimester of Pregnancy

Incidental Finding of Extreme Elevation of Serum Alkaline Phosphatase in Pregnancy

Does an abnormally elevated maternal alkaline phosphatase pose problems for the fetus?

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