What causes elevated liver enzymes during pregnancy?

There are several potential causes of elevated liver enzymes, also known as hepatic transaminases, during pregnancy:

Physiological Changes:

- Normal Pregnancy Changes: During pregnancy, there is an increase in the production of certain hormones, such as estrogen and progesterone, which can cause mild elevations in liver enzymes, particularly in the third trimester. These elevations are usually transient and do not indicate any underlying liver disease.

Conditions Related to Pregnancy:

- Obstetric Cholestasis: This is a pregnancy-specific liver condition characterized by the impaired flow of bile from the liver to the gallbladder. It typically occurs in the third trimester and can lead to elevated liver enzymes, particularly alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT). Itching of the skin, especially on the palms of the hands and soles of the feet, is a common symptom.

- Preeclampsia: A pregnancy-related condition characterized by high blood pressure and proteinuria (presence of protein in the urine). Severe preeclampsia can lead to elevated liver enzymes, as well as other signs of liver involvement.

- HELLP Syndrome: A serious pregnancy complication characterized by hemolysis (destruction of red blood cells), elevated liver enzymes, and low platelets. HELLP syndrome can progress rapidly and requires prompt medical intervention.

Infections:

- Viral Hepatitis: Infections like hepatitis A, hepatitis B, and hepatitis E can cause elevated liver enzymes during pregnancy. Hepatitis A is usually a mild illness, but hepatitis B and E can be more severe and require close monitoring.

Medications and Toxins:

- Medications: Certain medications, such as some antibiotics, anticonvulsants, and painkillers, can cause elevated liver enzymes as a side effect.

- Toxins: Exposure to toxic substances, such as certain chemicals or alcohol, can also lead to elevated liver enzymes.

Underlying Liver Conditions:

- Preexisting Liver Disease: Women with pre-existing liver conditions, such as chronic hepatitis, cirrhosis, or autoimmune liver diseases, may experience elevated liver enzymes during pregnancy.

Biliary Tract Disorders:

- Cholelithiasis: Presence of gallstones in the gallbladder or bile ducts can cause obstruction and lead to elevated liver enzymes, particularly ALP and GGT.

Differential Diagnosis:

- Differential Diagnosis: In some cases, elevated liver enzymes during pregnancy may be due to non-liver-related conditions, such as thyroid disorders or certain muscle disorders.

It's important to note that mild elevations in liver enzymes alone are not always a cause for concern during pregnancy. However, significant or persistent elevations require evaluation by a healthcare provider to determine the underlying cause and ensure appropriate management.