Liver enzymes are proteins within liver cells that aid metabolism and detoxification. When liver cells are damaged, these enzymes leak into the bloodstream, leading to elevated levels detectable by blood tests. During pregnancy, elevated liver enzymes require careful attention, as they can signal underlying conditions affecting both the pregnant individual and the fetus.
What Liver Enzymes Are and Why They Matter in Pregnancy
Common liver enzymes measured include Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Alkaline Phosphatase (ALP), and Gamma-Glutamyl Transferase (GGT). ALT is a specific indicator of liver cell damage, while AST is also found in the heart and muscles. ALP is present in the liver, bones, and placenta, and GGT is primarily in the liver and bile ducts. Monitoring these enzymes during pregnancy helps assess liver function and bile flow. Elevated levels generally indicate liver cell injury or bile excretion issues. A slight increase in ALP is normal in pregnancy due to placental production, but significant elevations of any liver enzyme are a concern.
Common Causes of Elevated Liver Enzymes During Pregnancy
Preeclampsia, characterized by high blood pressure and protein in the urine, can elevate liver enzymes due to liver involvement. HELLP syndrome, a severe form of preeclampsia, involves red blood cell breakdown, compromised liver function, and low platelets. Liver dysfunction in HELLP syndrome significantly increases ALT and AST, often with upper right abdominal pain.
Intrahepatic Cholestasis of Pregnancy (ICP) is a liver disorder marked by elevated liver enzymes. It typically causes intense itching, especially on the hands and feet, often worse at night. ICP involves impaired bile flow, leading to bile acid accumulation and elevated ALT, AST, and ALP levels.
Acute Fatty Liver of Pregnancy (AFLP) is a rare but severe condition developing in the third trimester or shortly after delivery. It involves widespread fatty infiltration of liver cells, causing liver dysfunction and a sudden, pronounced elevation of liver enzymes. AFLP progresses rapidly and requires urgent medical intervention due to potential severe complications.
Other factors can also contribute to elevated liver enzymes during pregnancy. These include viral hepatitis (A, B, or C), which causes liver inflammation, and gallstones, which can obstruct bile ducts and elevate ALP and GGT. Certain medications taken during pregnancy can also affect liver function and raise enzyme levels.
Recognizing Symptoms and Seeking Care
Common symptoms include severe itching, especially on the hands and feet, a primary indicator of Intrahepatic Cholestasis of Pregnancy. Other signs may involve fatigue, nausea, and vomiting.
Some individuals may experience upper right abdominal pain, associated with preeclampsia or HELLP syndrome. Jaundice, characterized by yellowing skin and eyes, dark urine, or light stools, also suggests liver dysfunction. Any of these symptoms or elevated enzymes on a blood test warrant immediate contact with a healthcare provider.
Diagnosis, Monitoring, and Treatment Approaches
Diagnosis of elevated liver enzymes begins with routine blood tests measuring ALT, AST, ALP, and GGT. If elevated, further specific blood tests identify the underlying cause, such as bile acid levels for Intrahepatic Cholestasis of Pregnancy or viral hepatitis markers. Imaging studies, like an abdominal ultrasound, may also assess the liver and gallbladder for abnormalities.
Monitoring involves repeat blood tests to track enzyme levels and assess treatment effectiveness. Depending on the cause, additional monitoring of blood pressure, urine protein, and fetal well-being may be necessary.
Treatment depends on the specific diagnosis. For Intrahepatic Cholestasis of Pregnancy, medications like ursodeoxycholic acid can reduce bile acid levels and alleviate itching.
For severe preeclampsia or HELLP syndrome, management often involves blood pressure control medications. In some cases, delivery of the baby, even if preterm, is the only definitive treatment. Supportive care, including rest and close medical supervision, helps ensure the best outcomes for both the pregnant individual and the baby.
Potential Impact on Maternal and Fetal Health
For the pregnant individual, complications may include liver dysfunction, increased bleeding risk due to impaired clotting, or other organ system issues. Severe conditions like HELLP syndrome can lead to liver rupture or kidney failure.
The baby may face risks such as preterm birth, leading to respiratory distress syndrome or other prematurity complications. Fetal distress, indicated by abnormal heart rate patterns, can also occur. However, with early diagnosis and appropriate medical management, most cases lead to positive outcomes for both the mother and the baby.