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Elevated Liver Enzymes in Pregnancy

Address elevated liver enzymes during pregnancy with specialized care. Understand causes, potential risks, and management options for optimal maternal and fetal health.

  • Gynecologyy
  • Hepatologyy

By Varsha Shetty

27th Jan '23

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Overview

  • A study published in the Journal of Obstetrics and Gynaecology of India found that the incidence of gestational cholestasis was higher in Indian women (0.9%) compared to a study of Swedish women (0.3%).
  • In the United States, studies have found that the overall incidence of elevated liver enzymes during pregnancy ranges from 0.5-5%.
  • In the United Kingdom, studies have found that the incidence of elevated liver enzymes during pregnancy is around 1%.
  • However, some specific causes of elevated liver enzymes, such as viral hepatitis and fatty liver disease, have a higher incidence.
  • A study published in the Journal of Obstetrics and Gynaecology Research found that the incidence of elevated liver enzymes in pregnant women with gestational diabetes was higher than in pregnant women without it.
  • The specific enzymes that are measured can also affect the incidence of elevated liver enzymes in pregnancy.
  • For example, the level of ALT is often used as an indicator of liver function.
  • However, a study published in the Journal of Obstetrics and Gynaecology Research found that the level of AST was a better indicator of gestational cholestasis than ALT.
  • And it was noted that high alkaline phosphatase levels during pregnancy could indicate bone diseases such as Paget's disease, rickets, and bone tumors.
     

Continue reading to understand what high liver enzymes in pregnancy can mean.

Are elevated liver enzymes normal in pregnancy?

Elevated liver enzymes during pregnancy can be indicative of underlying liver problems, such as hepatitis, liver pain, back pain, cirrhosis, cholestasis, and other health conditions. It is important to note that elevated liver enzymes are not considered normal during pregnancy.

Some common causes of elevated liver enzymes in pregnancy include:

  • Pre-eclampsia: A pregnancy-related condition characterized by high blood pressure and protein in the urine.
  • HELLP syndrome: A severe form of pre-eclampsia that can cause liver damage.
  • Gestational cholestasis (GC): Also known as cholestasis of pregnancy, GC is a condition that affects the liver's ability to metabolize bile properly.
  • Gestational hypertension: High blood pressure during pregnancy.
  • Viral hepatitis: Viral infections such as hepatitis A, B, C, D, and E can cause liver enzyme elevation.
  • There are many other causes of elevated liver enzymes that are not specific to pregnancy.
  • If you are pregnant and suspect that you have elevated liver enzymes, please consult your health gynecologist and hepatologist without delay. They will be able to help determine the cause of the elevation and recommend the appropriate treatment.

So, what are the different liver enzymes whose levels can impact pregnancy? Let’s find out.

 

What are the types of liver enzymes measured during pregnancy?

Various types of liver enzymes can be measured during pregnancy, including:

Types of liver enzymes measured during pregnancy

  • Alkaline phosphatase (ALP)
  • Alanine transaminase (ALT)
  • Aspartate transaminase (AST)
  • Bilirubin
  • Gamma-glutamyl transpeptidase (GGT)

These enzymes can evaluate liver function and detect potential issues, such as hepatitis or pre-eclampsia. It's important to note that the expected levels of these enzymes can vary during pregnancy. So they should be interpreted in the context of the individual patient and their specific medical history.

Do you have any concerns about your liver enzymes during pregnancy? Please ensure that you discuss them with your obstetrician or a specialist in liver disease.

Read on to get an idea of what liver enzyme levels are considered normal during pregnancy!

 

What causes elevated liver enzymes when pregnant?

As mentioned earlier, elevated liver enzymes during pregnancy can be caused by several pregnancy-related conditions, including:

Some other non-pregnancy-related conditions can also cause elevated liver enzymes during pregnancy. These include:

non-pregnancy related conditions that cause elevated liver enzymes during pregnancy

According to Evelina Sabonaityte Medical Doctor from Giejo stated that -

Genetics And Family History also Plays In Developing Elevated Liver Enzymes In Pregnancy.Elevated liver enzymes during pregnancy can be a sign of intrahepatic cholestasis of pregnancy (ICP). Genetics as well as family history can play a role in the development of ICP. Women with a family history of ICP are at an increased risk of developing ICP. It is important to note research on the matter is still ongoing.

Normal values of liver enzymes in pregnancy

The normal levels of liver enzymes during pregnancy can vary based on the particular enzyme being gauged and the laboratory that is performing the test. However, in general, the following ranges are considered to be expected for pregnant women:

Normal ALT levels in pregnancy5-40 units/liter
Normal AST levels in pregnancy5-40 units/liter
Normal ALP levels in pregnancy30-120 units/liter
Normal GGT levels in pregnancy5-35 units/liter
Normal Bilirubin Levels in Pregnancy0.2-1.2 mg/dl

Note: Please remember that these ranges can be affected by the gestational age of the pregnancy. It is best to discuss any concerns about your liver enzyme levels with your obstetrician or a specialist in liver disease at the best hospital for better treatment.

Take charge of your health and your life. Contact us today! 
 

Are you concerned about the chances of raised liver enzymes in pregnancy? Let’s look at the numbers.

           

Chances of liver enzymes increasing in pregnancy

The chances of liver enzymes going high during pregnancy vary depending on the specific enzyme and the underlying cause of the elevation.

Condition

Affected pregnancies

Symptoms

Cholestasis of pregnancyAbout 1 in 140 pregnanciesLiver unable to properly metabolize bile
Pre-eclampsia3-5% of pregnanciesHigh blood pressure and protein in the urine
HELLP syndrome1 in 2,000 pregnanciesLiver damage
Gestational hypertension5-8% of pregnanciesHigh blood pressure

Viral hepatitis is not common during pregnancy, except in pregnant women who have a high risk of hepatitis, including those who have a history of:

  • travel to countries with high hepatitis prevalence
  • blood transfusion
  • drug abuse

Please note that elevated liver enzymes during pregnancy may not cause any noticeable symptoms. However, in some cases, women may experience symptoms such as:

  • Fatigue
  • Weakness
  • Loss of appetite
  • Nausea
  • Abdominal pain ( may be due to formation of gallstones )
  • Jaundice (yellowing of the skin and eyes).

These symptoms can also be caused by other conditions, so it's essential to consult with a doctor at the best hospital for an accurate diagnosis and management. Additional tests and monitoring may be required if symptoms are severe or if there are signs of liver dysfunction.

 

It is always important to have yourself tested for liver enzyme levels to rule out complications and get the necessary treatment on time.

 

Treatment for elevated liver enzymes in pregnancy

Treatment for elevated liver enzymes during pregnancy depends on the underlying cause of the elevation. Some common treatments include:

Condition

Treatment

Cholestasis of pregnancy

Ursodeoxycholic acid - a medication that helps to reduce the symptoms of itching and improve the flow of bile

Pre-eclampsia

Close monitoring of blood pressure, protein in the urine, and liver enzymes

HELLP syndrome

Close monitoring of blood pressure, protein in the urine, and liver enzymes

Gestational hypertension

Close monitoring of blood pressure and liver enzymes. May include medications to lower blood pressure

Viral hepatitis

Antiviral therapy can be effective in preventing the progression of liver disease and reducing the risk of maternal and fetal complications.

 

Treatment for other non-pregnancy-related causes of elevated liver enzymes will depend on the underlying condition. For example, if the reason is cancer, the treatment will be directed to the cancer. If the cause is a genetic disorder, the treatment will depend on the specific disorder.

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What happens if elevated liver enzymes are not treated during pregnancy?

If elevated liver enzymes are not treated during pregnancy, it can lead to potential complications for both the mother and the baby.

Elevated liver enzymes can indicate liver dysfunction or damage, which can lead to further liver damage if left untreated. This can result in conditions such as:

if elevated liver enzymes are not treated during pregnancy

Note: HELLP syndrome (a severe complication of pregnancy indicated by Hemolysis, Elevated Liver enzymes, and Low Platelet count)

Hence, it is essential to consult with your doctor to determine the cause of the elevated enzymes and to develop a treatment plan. Depending on the cause, treatment may involve changes in medication, lifestyle, or close monitoring during pregnancy.

 

In case you’re wondering how elevated liver enzymes during pregnancy can be avoided, here are some tips.

Tips to lower the risk of elevated liver enzymes during pregnancy

Tips to lower the risk of elevated liver enzymes during pregnancy

Various factors can cause elevated liver enzymes during pregnancy, and it may not always be possible to avoid them. However, certain steps can be taken to minimize the risk of liver enzyme elevation during pregnancy:

  • Maintaining a healthy lifestyle, that is, eating a well-balanced diet, exercising regularly, and avoiding alcohol and tobacco.
  • Managing any pre-existing medical conditions that can increase the risk of liver dysfunction, such as diabetes and obesity.
  • Avoid certain medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), that can cause liver enzyme elevations.
  • Getting vaccinated against hepatitis A and B can reduce the risk of viral hepatitis.
  • Consult with your healthcare provider if you have any symptoms of morning sickness as hyperemesis gravidarum can cause liver enzyme elevations. The symptoms of hyperemesis gravidarum can include severe nausea and vomiting.

In some cases, the cause of elevated liver enzymes during pregnancy may be unknown and cannot be avoided. Therefore, it's important to consult with your doctor for regular check-ups and pregnancy monitoring to minimize potential risks.


 

Elevated levels of liver enzymes can be a sign of liver damage or disease. If you have concerns about your liver enzymes during pregnancy, it is best to discuss them with your obstetrician or hepatologist. They will be able to help determine the cause of the elevation and recommend the appropriate treatment.

If you have more questions, don’t worry. We are here to help you!

Call today and get free Consultation!

 

References:

https://www.walshmedicalmedia.com/open-access/liver-function-tests-in-normal-pregnant-women-2167-0889-1000228.pdf

https://www.uptodate.com/contents/approach-to-evaluating-pregnant-patients-with-elevated-liver-biochemical-and-function-tests

https://www.frontiersin.org/articles/10.3389/fcvm.2022.963957/full

https://www.aafp.org/pubs/afp/issues/1999/0215/p829.html

Frequently Asked Questions

How common are elevated liver enzymes in pregnancy?

What are the causes of elevated liver enzymes in pregnancy?

What are the symptoms of elevated liver enzymes in pregnancy?

How is elevated liver enzymes in pregnancy diagnosed?

How are elevated liver enzymes in pregnancy treated?

What are the risks of elevated liver enzymes in pregnancy?

Can elevated liver enzymes in pregnancy lead to preterm labor?

How can I prevent elevated liver enzymes in pregnancy?

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