title: Association of antenatal antithrombin activity with perinatal liver dysfunction: A prospective multicenter study.
abstract: OBJECTIVE
  Liver dysfunction with decreased antithrombin (AT) activity and/or thrombocytopenia is life threatening in pregnant women. Whether AT is clinically useful for prediction of liver dysfunction remains unclear.
  
  
  METHODS
  A total of 541 women were registered prospectively at gestational week 34.7 (20.0-41.4) with available data on antenatal AT and platelet count (PLC).
  
  
  RESULTS
  Liver dysfunction defined as serum aspartate aminotransferase > 45 IU/L concomitant with lactate dehydrogenase > 400 IU/L occurred in five women antenatally (≤ 2 weeks before delivery) and in 17 women post-partum (within 1 week post-partum). Median (5th-95th) antenatal value was 85 (62-110)% for AT and 202 (118-315) × 109/L for PLC in the 541 women and was significantly lower in women with than without perinatal liver dysfunction; 75 (51-108) versus 86 (62-110)% and 179 (56-244) versus 203 (121-316) × 109/L, respectively. Nineteen (86%) women with liver dysfunction showed AT ≤ 62% or thrombocytopenia (PLC ≤ 118 × 109/L) perinatally, but five lacked thrombocytopenia throughout the perinatal period. The best cut-off (AT, 77%; PLC, 139 × 109/L) suggested by receiver operating characteristic curve gave antenatal AT and PLC sensitivity of 59% and 41% with positive predictive value of 8.6% and 14%, respectively, and combined use of AT and PLC improved sensitivity to 73% (16/22) with positive predictive value of 9.2% for prediction of perinatal liver dysfunction.
  
  
  CONCLUSIONS
  Reduced AT not accompanied by thrombocytopenia can precede liver dysfunction. Clinical introduction of AT may enhance the safety of pregnant women.
authors.affiliation: Department of Obstetrics, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Morikawa
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University Hospital, Shimotsuke, Japan.
authors.forename: Hirotada
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Department of Obstetrics and Gynecology, University of Tsukuba Hospital, Tsukuba, Japan.
authors.forename: Mana
authors.initials: M
authors.lastname: Obata-Yasuoka
authors.affiliation: Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Michi
authors.initials: M
authors.lastname: Kasai
authors.affiliation: Department of Obstetrics and Gynecology, Hamamatsu University Hospital, Hamamatsu, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Itoh
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University Hospital, Shimotsuke, Japan.
authors.forename: Akihide
authors.initials: A
authors.lastname: Ohkuchi
authors.affiliation: Department of Obstetrics and Gynecology, University of Tsukuba Hospital, Tsukuba, Japan.
authors.forename: Hiromi
authors.identifier: http://orcid.org/0000-0002-0560-7034
authors.initials: H
authors.lastname: Hamada
authors.affiliation: Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Aoki
authors.affiliation: Department of Obstetrics and Gynecology, Hamamatsu University Hospital, Hamamatsu, Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Kanayama
authors.affiliation: Department of Obstetrics, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Hisanori
authors.initials: H
authors.lastname: Minakami
mesh_terms: D000293:Adolescent; D000328:Adult; D000991:Antithrombins / Q000032:analysis*; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D005260:Female; D005865:Gestational Age; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008107:Liver Diseases / Q000175:diagnosis / Q000209:etiology*; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013921:Thrombocytopenia / Q000097:blood; D019851:Thrombophilia / Q000097:blood; D055815:Young Adult
chemical_list: D000991:Antithrombins; D015415:Biomarkers; D007770:L-Lactate Dehydrogenase; D001219:Aspartate Aminotransferases
keywords: HELLP syndrome; acute fatty liver of pregnancy; antithrombin activity; disseminated intravascular coagulation; maternal mortality; pregnancy complication