Liver function test and pregnancy

Abstract

The physiological changes in liver function in pregnancy are commonly transient, rarely permanent. Disorders arising in pregnancy, such as pre-eclampsia and eclampsia, acute fatty liver of pregnancy (AFLP), haemolysis, elevated liver enzyme and low platelets (HELLP) syndrome, cholestasis, hyperemesis gravidarum and isolated cases of raised liver enzymes can have serious implications. Proper interpretation of liver function tests (LFTs) at an early stage can lead to timely management and may reduce complications in both mother and fetus. Normal LFTs do not always mean that the liver is normal. A number of pitfalls can be encountered in the interpretation of basic blood LFTs. The commonly used LFTs primarily assess liver injury rather than hepatic function. Abnormal LFTs may indicate that something is wrong with the liver, and they can provide clues to the nature of the problem but this is not always the case. The various biochemical tests, their pathophysiology, and an approach to the interpretation of abnormal LFTs are discussed in this review. Commonly available tests include alanine transaminase, aspartate transaminase, alkaline phosphatase, bile acid, serum bilirubin, serum albumin and prothrombin time.

Anti-Fibrotic Effect of Plumbagin on CCl4-Lesioned Rats

“…In clinical practice, liver function is tested through determining transaminase serum levels, in which high concentrations of these enzymes can reflect liver lesions [25]. Furthermore, cytokines may promote inflammatory development via a wide variety of cascade events.…”

Intrahepatic cholestasis of pregnancy: Correlation of preterm delivery with bile acids

“…The etiology of ICP is unknown, although current investigations suggest a combination of hormonal, genetic and inflammatory factors that impair bile secretory function, which acts to increase maternal SBAs and elevate liver enzymes (2)(3)(4)(5). According to several studies, although the maternal course is usually benign, the fetus faces an increase risk of spontaneous preterm delivery, fetal compromise, meconium-stained amniotic fluid, and intrauterine fetal demise (1,2,6).…”

Liver Failure in Pregnancy

“…6,7 The liver may be slightly elevated within the abdomen with increasing gestation, owing to displacement by the enlarging uterus. 8 However, hepatomegaly is abnormal and should prompt an immediate evaluation of underlying liver disease.…”

“…Liver enzymes including alanine aminotransferase (ALT), aspartate aminotransferase (AST), g-glutamyl transferase (GGT), and bilirubin remain normal or may decrease about 20% in pregnancy compared with the nonpregnant patient. 6,7 Alkaline phosphatase (ALP) increases with advancing gestation as a result of placental production, and high levels should not be considered abnormal. Total protein decreases during pregnancy, primarily because of a decrease in serum albumin.…”