During pregnancy, some liver enzymes are normally elevated as part of the physiologic changes of pregnancy, while others are not. Abnormal liver enzyme elevations occur in 5 percent of pregnancies, according to J. Eileen May in "Mayo Clinic Gastroenterology and Hepatology Board Review." Elevated liver enzymes in pregnancy can indicate serious liver damage.
Definition
One type of liver enzyme, alkaline phosphatase, normally rises to two to four times its normal range of 35 to 110 international units per liter, or IU/L, in pregnancy. Two other liver enzymes, AST and ALT, should not rise during pregnancy. Normal ALT levels range from 0 to 45 IU/L and AST from 0 to 40 IU/L.
Causes
Several serious pregnancy complications can cause a rise in liver enzymes. Pre-eclampsia, the onset of high blood pressure and protein in the urine after 20 weeks of pregnancy, occurs in between 3 and 7 percent of pregnancies, the Merck Manuals Online Medical Library reports. Pre-eclampsia advances to eclampsia with the development of seizures in 1 in 200 women with pre-eclampsia. HELLP syndrome, which stands for hemolysis, elevated liver enzymes and low platelets, affects less than 1 percent of all pregnancies, according to the March of Dimes. HELLP syndrome occurs as a complication of pre-eclampsia. Acute fatty liver of pregnancy, or AFLP, affects approximately 1 in 13,000 pregnancies, according to the Emory University School of Medicine. Viral hepatitis A, B or C can also cause elevated liver enzymes in pregnancy.
Complications
Chronic hepatitis rarely causes maternal complications during pregnancy, but if the baby contracts hepatitis B, as occurs in 10 to 20 percent of cases, the infant will have the disease and an increased risk of liver failure or cancer as an adult, according to the March of Dimes. Hepatitis C infects the fetus in around 4 percent of cases. The serious liver disorders that occur only in pregnancy can all result in death or brain damage in the mother or fetus if not promptly treated. The pregnancy may have to be terminated early, resulting in preterm delivery of the fetus.
Treatment
The treatment for acute fatty liver, HELLP, pre-eclampsia and eclampsia is delivery of the infant. Giving infants exposed to hepatitis B the hepatitis B vaccine within 12 hours of birth prevents transmission to the infant in more than 90 percent of cases, the March of Dimes states. At this time, there is no vaccine to prevent transmission of hepatitis C to the infant.
Long-Term Complications
There is no treatment to cure hepatitis B or C, although antiviral treatment can help clear the virus. Hepatitis A is normally self-limiting. HELLP, fatty liver and eclampsia normally improve within a few days after delivery without long-term complications unless mother or baby suffered brain damage or other permanent injury from the illness.
References
- "Mayo Clinic Gastroenterology and Hepatology Board Review, Third Edition"; by C. Hauser Stephen, Darrell S. Pardi, and John J. Poterucha; 2008
- The Merck Manuals Online Medical Library: Preeclampsia and Eclampsia
- Emory University School of Medicine: HELLP, AFLP and FAOD
- March of Dimes: Pregnancy Complications; Liver Disorders
- liverdisease: Liver Enzymes
