Factors influencing postnatal liver function tests.
OBJECTIVE
To investigate liver function tests (LFTs) changes in the puerperium and the influence of specific obstetric events on these changes.


METHODS
A longitudinal observational study.


METHODS
West Middlesex University Hospital, Twickenham.


METHODS
Ninety-four women with uncomplicated pregnancy who delivered at term.


METHODS
Aspartate transaminase (AST), alanine transaminase (ALT), gamma glutamyl transferase (GGT), total bilirubin (Bilirubin) and alkaline phosphatase (ALP) were measured in early labour and on day 1, day 2, day 5 and day 10 postnatal.


METHODS
Peak enzyme concentration, time of peak enzyme concentration, the area under the curve for each enzyme and the rate of change of enzyme level from predelivery to peak concentration.


RESULTS
All LFTs were affected by delivery (P < 0.001), increasing by 88% (0-500%) on day 2 or day 5 for AST, 147% (0-1140%) on day 5 for ALT and 63% (0-450%) on day 5 or day 10 for GGT. Multiple linear regression showed that caesarean section and opioid administration was associated with a faster rise in AST (P = 0.001, P = 0.033 respectively). The mean peak GGT concentration was 39% higher in women having caesarean section compared with vaginal delivery (P = 0.015). Univariate analysis showed that perineal trauma, use of Entonox, maternal age at delivery and breastfeeding also influenced LFT concentration significantly.


CONCLUSIONS
Liver enzyme levels change significantly in the puerperium and are affected by common obstetric events, particularly caesarean section. This study aids clinical interpretation of postnatal LFTs in women recovering from liver-related illnesses, by facilitating the differentiation of physiological and pathological processes.
David
A L
AL
Department of Obstetrics and Gynaecology, West Middlesex University Hospital, Isleworth, UK.
Kotecha
M
M
Girling
J C
JC
D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D016362:Analgesia, Obstetrical; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001903:Bottle Feeding; D001942:Breast Feeding; D002585:Cesarean Section; D004739:England; D005260:Female; D006801:Humans; D008099:Liver / Q000201:enzymology*; D008111:Liver Function Tests / Q000379:methods; D008137:Longitudinal Studies; D008423:Maternal Age; D049590:Postpartum Period / Q000378:metabolism; D011247:Pregnancy; D011446:Prospective Studies; D005723:gamma-Glutamyltransferase / Q000097:blood
D015415:Biomarkers; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase; D001663:Bilirubin