title: Maternal electrolyte and liver function changes during pregnancy at high altitude.
abstract: BACKGROUND
  High-altitude (HA) hypoxia leads to profound cardiovascular, respiratory and electrolyte changes, and pregnancy at HA has been associated with increased incidence of preeclampsia and intrauterine growth restriction.
  
  
  OBJECTIVE
  To examine the effect of high altitude on maternal serum electrolytes and liver enzymes.
  
  
  METHODS
  Cross-sectional study of 77 pregnant women at 6-40 weeks of gestation resident at HA (4370 m above sea level) and 80 at sea level (SL) and 13 and 15 nonpregnant women at each altitude, respectively. Serum electrolytes (sodium, potassium, calcium and phosphate), creatinine, bilirubin and liver enzymes (alkaline phosphatase (ALP), aspartate transaminase (AST) and gamma-glutamyl transferase (gamma-GT)) were measured.
  
  
  RESULTS
  Pregnancy at HA, compared to SL, was associated with higher serum osmolality (0.4%), sodium (0.7%), creatinine (14%) and phosphate (5%) concentrations and lower potassium (10%) concentration. Calcium and albumin-corrected calcium concentrations were higher at HA compared to SL in nonpregnant women (8%), with no difference in pregnant women. AST, gamma-GT and ALP concentrations were not significantly different between HA and SL, neither in pregnant nor in nonpregnant women. AST and gamma-GT were lower in pregnant compared to nonpregnant women (30%) at HA, whereas the difference was not significant at SL. Total bilirubin concentrations were higher at HA compared to SL by about 25% both in pregnant and in nonpregnant women, the difference reaching statistical significance only in the pregnant group.
  
  
  CONCLUSIONS
  Pregnancy at HA is associated with increased osmolality, sodium, creatinine, calcium, phosphate and total bilirubin concentrations. Liver enzyme activities are similar to SL.
authors.affiliation: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
authors.forename: Nikos
authors.initials: N
authors.lastname: Kametas
authors.forename: Fionnuala
authors.initials: F
authors.lastname: McAuliffe
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Krampl
authors.forename: Roy
authors.initials: R
authors.lastname: Sherwood
authors.forename: Kypros H
authors.initials: KH
authors.lastname: Nicolaides
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000531:Altitude; D001219:Aspartate Aminotransferases / Q000097:blood; D004573:Electrolytes / Q000097:blood*; D005260:Female; D006801:Humans; D008099:Liver / Q000502:physiology*; D011247:Pregnancy / Q000502:physiology*
chemical_list: D004573:Electrolytes; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase