Activity of hepatic enzymes from week sixteen of pregnancy Angeles Ruiz-Extremera, MD, a, * Marı ´a A. Lo ´ pez-Garrido, MD, b Enriqueta Barranco, MD, c Marı ´a D. Quintero, MD, b Esther Ocete-Hita, MD, a Paloma Mun ˜oz de Rueda, PhD, b Ana Gila, MD, b Javier Salmero ´n, MD b Pediatrics Service, a Gastroenterology Unit, b and Department of Obstetrics and Gynecology, c H. Universitario San Cecilio, Granada, Spain Received for publication December 17, 2004; accepted April 19, 2005 KEY WORDS Pregnancy Liver enzymes Alanine- aminotransferase Objective: This study was undertaken to determine the prevalence, epidemiology, and mother- child repercussions of increased alanine-aminotransferase levels from week 16 of pregnancy. Study design: A longitudinal observational study of 381 pregnant women. The cause of increased alanine-aminotransferase levels during pregnancy and repercussions on the neonate were studied in 283 cases. Statistical analysis was performed with Mann-Whitney test, c 2 test, or the Fisher exact test. Results: The mean age of the mothers was 29.9 G 4.8 years. Twenty-five percent presented increased gamma-glutamyl-transpeptidase, alkaline phophatase, and dehydrogenase lactate from week 32. Increased alanine-aminotransferase was observed in 7.4% (95% CI, 5.00%-10.57%) of cases. Clinical disorders were light, transitory, and with no apparent cause, except for 1 hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, 3 preeclampsias, and 1 gravidic cholestasis. No statistically significant differences were observed in the group of mother-child with alanine-aminotransferase normal or increased. Conclusion: Most increases in alanine-aminotransferase from week 16 of pregnancy are transitory, non-specific, and have no repercussions on mother or child. Ó 2005 Mosby, Inc. All rights reserved. During pregnancy, liver disorders may occur, with varying, but sometimes extremely severe clinical effects. Comprehensive studies have been made of the hemoly- sis, elevated liver enzymes, low platelets (HELLP) syn- drome, gravidic cholestasis, the fatty liver of pregnancy, and other preexisting liver diseases, whether concomi- tant or pregnancy associated. 1-8 However, few studies have been carried out concerning the prevalence of liver disorders and the effects of pregnancy on the biochem- ical profile. Previous studies have reported a reduction in total bilirubin (BRRt), 9 in the free fraction and in gamma-glutamyl-transpeptidase (GGT), 9-12 as well as an increase in alkaline phosphatase (ALP) 9 through the placenta isoenzyme and in alanine-aminotransferase (ALT). 9-11 These changes are evident on comparison Support provided by the Government of Spain FIS 97/0378 and Instituto de Salud ‘‘Carlos III’’ RNIHG C03/02. * Reprint requests: Angeles Ruiz-Extremera, MD, Department of Pediatrics, ‘‘San Cecilio’’ University Hospital, Avda Dr Oloriz no 16, 18012- Granada, Spain. E-mail: arextrem@ugr.es 0002-9378/$ - see front matter Ó 2005 Mosby, Inc. All rights reserved. doi:10.1016/j.ajog.2005.04.045 American Journal of Obstetrics and Gynecology (2005) 193, 2010–6 www.ajog.org