title: Liver dysfunction in women with pregnancy-induced antithrombin deficiency.
abstract: OBJECTIVE
  The aim of this study was to determine whether women with pregnancy-induced antithrombin deficiency (PIATD) had higher risk of liver dysfunction in the absence of thrombocytopenia.
  
  
  METHODS
  We carried out a retrospective observational study at five centers in all 129 women with incidentally found PIATD among 5249 maternities and 129 control women without PIATD matched for number of fetuses and gestational week at delivery. PIATD was diagnosed in women with antenatal antithrombin (AT) activities of ≤75% followed by a further decrease to ≤65% peripartum. Liver dysfunction was defined as serum aspartate aminotransferase >  45 IU/L concomitant with lactate dehydrogenase >  400 IU/L. Thrombocytopenia was defined as platelet count < 120 × 109/L.
  
  
  RESULTS
  Thrombocytopenia (22% [28/129] vs 5.4% [7/129], P =  0.0001) and liver dysfunction (16% [20/129] vs 0.0% [0/129], P =  0.0000) occurred significantly more often in PIATD than in control women. Of the 20 women with liver dysfunction, 15 (75%) had PIATD, but not thrombocytopenia. Thus, even in the absence of thrombocytopenia, liver dysfunction occurred significantly more often in PIATD than in control women (15% [15/101] vs 0.0% [0/122], respectively, P =  0.0000). The relative risk (95% confidence interval) of liver dysfunction was 28.6 (1.64-500) for women with AT activity of 60-65% and 52.4 (3.17-865) for women with AT activity of <60%, compared to women with AT activity ≥66%.
  
  
  CONCLUSIONS
  PIATD can occur in the absence of thrombocytopenia and PIATD women had higher risk of liver dysfunction even in the absence of thrombocytopenia.
authors.affiliation: Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Morikawa
authors.affiliation: Department of Obstetrics and Gynecology, Hakodate Central General Hospital, Hakodate, Japan.
authors.forename: Kosuke
authors.identifier: http://orcid.org/0000-0001-6167-2984
authors.initials: K
authors.lastname: Kawabata
authors.affiliation: Department of Obstetrics and Gynecology, Sapporo City General Hospital, Sapporo, Japan.
authors.forename: Emi
authors.initials: E
authors.lastname: Kato-Hirayama
authors.affiliation: Department of Obstetrics and Gynecology, Japan Community Health Care Organization Hokkaido Hospital, Sapporo, Japan.
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Oda
authors.affiliation: Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Ueda
authors.affiliation: Department of Obstetrics and Gynecology, Hakodate Central General Hospital, Hakodate, Japan.
authors.forename: Soromon
authors.identifier: http://orcid.org/0000-0001-7197-8258
authors.initials: S
authors.lastname: Kataoka
authors.affiliation: Department of Obstetrics and Gynecology, Japan Community Health Care Organization Hokkaido Hospital, Sapporo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Department of Obstetrics and Gynecology, Sapporo City General Hospital, Sapporo, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Okuyama
authors.affiliation: Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Sengoku
authors.affiliation: Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Hisanori
authors.initials: H
authors.lastname: Minakami
mesh_terms: D000328:Adult; D020152:Antithrombin III Deficiency / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000453:epidemiology*; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000453:epidemiology*; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000453:epidemiology*
keywords: HELLP syndrome; acute fatty liver of pregnancy; liver dysfunction; pregnancy complications