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

Mukesh G. Gohel, Anant G. Joshi, Jitendra S. Anand, Jemil S. Makadia, Chandrakant P. Kamariya

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.


Keywords


Liver function tests, Pregnancy, Liver diseases

Full Text:

PDF

References


Cunningham FG. Maternal physiology. In: Kenneth JL, Steven LB, John CH, Larry CG, Katharine DW. Williams Obstetrics. 22nd ed. New York, McGraw-Hill; 2005: 122-150.

Blackburn ST and Loper DL. Maternal, fetal and neonatal physiology. A clinical perspective, 3rd ed. Elsevier saunders, Philadelphia. 2007: 92-104.

Rodin A, Duncan A, Quartero HWP, Pistofidis G, Mashiter G, Whitaker K, Crook D, et al. Serum concentrations of alkaline phosphatase isoenzymes and osteocalcin in normal pregnancy. J Clin Endocrinol Metab 1989;68:1123–1127.

Pradumna J, Amir A, Tarun G, Philip B. Liver function test and pregnancy. The Journal of Maternal, Fetal & Neonatal Medicine 2009;22(3):274-83.

Knopp RH, Bergelin RO, Wahl PW, Walden CE, Chapman MB. Clinical chemistry alterations in pregnancy and oral contraceptive use. Obstet Gynecol 1985;66:682–690.

Salgo L, Pal A. Variation in some enzymes in amniotic fluid and maternal serum during pregnancy. Enzyme 1989;41:101–107.

Elliott JR, O'Kell RT. Normal clinical chemical values for pregnant women at term. Clin Chem 1971;17:156–157.

Meade BW, Rosalki SB. Serum enzyme activity in normal pregnancy and the newborn. Journal of Obstetrics and Gynaecology 1963;70:693–700.

Moniz C, Nicolaides KH, Keys D, Rodeck CH. Gamma-glutamyl transferase activity in fetal serum, maternal serum, and amniotic fluid during gestation. J Clin Pathol 1984;37:700–703.

Combes B, Shore GM, Cunningham FG, Walker FB, Shorey JW, Ware A. Serum gamma-glutamyl transpeptidase activity in viral hepatitis: suppression in pregnancy and by birth control pills. Gastroenterology 2007;72:271–274.

Back Y, Zarka O, Brechot JF, Mariotte N, Vol S, Tichet J and Weill J. Liver function tests in normal pregnancy: A prospective study of 103 pregnant women and 103 matched controls. Hepatology 1996;23(5):1030-1034.

Loganathan G, George R, Eapen CE, Mathai M, Jasper P, Seshdri L, Shankar V, Paul S, Joseph G, Balsubramanian KA, Chandy GM. Liver function tests in normal pregnancy: a study from southern India. Indian Journal of Gastroenterology 2005;24:268-269.

Salman MI. Changes in liver function tests during pregnancy. Journal of al-anbar university for pure Science 2009;3(1):209-212.