Ushida Takafumi, Kotani Tomomi, Kinoshita Fumie, Imai Kenji, Nakano-Kobayashi Tomoko, Nakamura Noriyuki, Moriyama Yoshinori, Yoshida Shigeru, Yamashita Mamoru, Kajiyama Hiroaki
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Division of Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):5761-5767. doi: 10.1080/14767058.2021.1892633. Epub 2021 Feb 28.
There are conflicting reports on the effect of pregnancy on liver transaminase (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) levels. In this study, we sought to investigate the trajectories of AST and ALT levels during normal pregnancy and to compare them with AST and ALT levels of matched nonpregnant controls.
Our multicenter retrospective study included 34,396 women who delivered at term at 12 primary maternity care units between January 2011 and December 2018 and 57,152 nonpregnant women younger than 45 years who received a medical checkup between 2016 and 2019. After matching at a ratio of 1:1 for adjustment of several factors (age, weight, and height), a total of 30,460 normal pregnant women and 30,460 nonpregnant women were selected for this study. We measured serum AST and ALT levels during each trimester and the postpartum period to compare with those of the nonpregnant women.
The ALT level began to decrease in the first half of the third trimester and was lowest in the second half of third trimester and at postpartum day 1 (median [interquartile range]: 8 [6-11] U/L, 8 [6-10] U/L, respectively). The decline reversed and returned to the level of a nonpregnant state by postpartum days 2-7. The AST level remained unchanged regardless of pregnancy. The prevalence of abnormal liver transaminases (AST >40 U/L and ALT >40 U/L) was <1% at third trimester; however, it increased to 3-5% on postpartum days 2-7.
The ALT level was lower during pregnancy compared with nonpregnant women matched for several factors, whereas the AST level remained unchanged during pregnancy. Understanding the trajectories of AST and ALT levels during pregnancy may facilitate early recognition and diagnosis of impaired liver function, including liver disease and pregnancy complications that affect liver transaminases, such as pre-eclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome.
关于妊娠对肝转氨酶（天冬氨酸转氨酶[AST]和丙氨酸转氨酶[ALT]）水平的影响，存在相互矛盾的报道。在本研究中，我们试图调查正常妊娠期间AST和ALT水平的变化轨迹，并将其与匹配的非妊娠对照组的AST和ALT水平进行比较。
我们的多中心回顾性研究纳入了2011年1月至2018年12月期间在12个主要产科护理单位足月分娩的34396名女性，以及2016年至2019年期间接受体检的57152名年龄小于45岁的非妊娠女性。在按年龄、体重和身高比例1:1匹配以调整多个因素后，本研究共选取了30460名正常妊娠女性和30460名非妊娠女性。我们在妊娠各期及产后测量血清AST和ALT水平，以与非妊娠女性的水平进行比较。
ALT水平在妊娠晚期前半期开始下降，在妊娠晚期后半期及产后第1天最低（中位数[四分位间距]：分别为8[6 - 11]U/L、8[6 - 10]U/L）。这种下降在产后第2 - 7天逆转并恢复到非妊娠状态的水平。无论妊娠情况如何，AST水平保持不变。妊娠晚期肝转氨酶异常（AST>40 U/L且ALT>40 U/L）的患病率<1%；然而，在产后第2 - 7天增加到3 - 5%。
与匹配了多个因素的非妊娠女性相比，妊娠期间ALT水平较低，而AST水平在妊娠期间保持不变。了解妊娠期间AST和ALT水平的变化轨迹可能有助于早期识别和诊断肝功能受损，包括肝病以及影响肝转氨酶的妊娠并发症，如子痫前期和HELLP（溶血、肝酶升高和血小板减少）综合征。
