Idiopathic liver function test abnormality in pregnancy is associated with assisted reproduction techniques

Objective: To examine the prevalence, etiology, risk factors, and outcomes of liver abnormality in pregnancy, in a tertiary medical center, and to study the potential impact of artificial reproduction techniques (ART) on the incidence and the outcome of pregnancy-related liver abnormality. Design: A retrospective case-control study using an electronic database and patients' files. Setting: Tertiary referral center. Patient(s): Women in the third trimester of pregnancy who were hospitalized for delivery. Intervention(s): None. Main Outcome Measure(s): Development of significant elevation of alanine aminotransferase (ALT ≥100 IU/L). Secondary outcomes included development of maternal and fetal complications. Result(s): The upper limit of normal of ALT was ≥1.5 times and it occurred in 440 (1.6%) pregnancies; of those, 228 (0.8%) had ALT ≥100 IU/L. The etiology of significant liver test abnormality was idiopathic in 47% of patients. Compared with spontaneous pregnancies (295/23,793), ART was significantly associated with liver test abnormality (145/4, 520). The presence of ALT ≥100 IU/L in the third trimester was associated with higher rates of cesarean sections, prematurity, low birthweight, and fetal complications. Conclusion(s): A definite etiology was not determined in about half of pregnancy-Associated liver test abnormality. The ART was significantly associated with liver test elevation. Significant liver test abnormality in the third trimester may have an impact on maternal and fetal/neonatal outcomes.