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Gastroenterology  (Expert Forum)
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Help - Elevated liver enyzmes (AST § ALT) after pregnancy!
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D. Boston - MA
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MedHelp Member's Question

Help - Elevated liver enyzmes (AST § ALT) after pregnancy!

by suzan99, Mar 27, 2003 12:00AM
I am a 40 year old female who gave birth in January.  I just found out that my liver enyzmes are elevated.  My AST is 39 and my ALT is 88.  I am very concerned to say the least, worried about liver disease while caring for a newborn.  My cholestrol was 237 and my LDL is 150.  All other tests were normal.  I waited 2 weeks and re-did the tests and they were in the same range.



I have had maybe 10 drinks in the past year. Previous to that I drank once a week (3 beers) I don't take drugs, only sinutab a few times a month and am still taking prenatal vitamins.  About three years ago before being diagnosed with fibromyalgia I had all sorts of tests done including hepatitis B & C which were all negative, and normal liver enzymes. I doubt I could have contracted it since then.  I have no tattoes or piercings either.



I am totally stressing since I can't see my doctor until Tuesday.  What tests will they do - am I having liver failure?  Is this commom in pregnancy?  Should I stop nursing my baby?  Please help!
Doctor's Answer

by Kevin Pho, MD, Mar 27, 2003 12:00AM
Hello - thanks for asking your question.



As you know, there are many reasons why your liver enzymes are elevated.  



There are conditions during pregnancy that can elevated liver enzymes, chiefly preeclampsia or the HELLP (hemolytic anemia, elevated liver enzymes, low platelets) syndrome.  Preeclampsia is a form of pregnancy-related hypertension - the HELLP syndrome is seen as a more severe form.  Elevated liver enzymes can be seen in either disorder.  



However, delivery of the infant should decrease the liver enzymes in these cases.  There are times where it may present after delivery, but in most cases this occurs within 7 days.  



Another consideration would be acute fatty liver of pregnancy or intrahepatic cholestasis of pregnancy (impairment of bile excretion).  Both of these diseases can present after delivery.  



Non-pregnancy liver diseases should also be considered.  This includes hepatitis, hemochromatosis, gallbladder disease, any medication, autoimmune disorders or hepatic steatosis and an associated condition, non-alcoholic steatohepatitis (NASH).  



A good place to start would be an abdominal ultrasound to image the liver and gallbladder.  Tests for hepatitis, hemochromatosis, and autoimmune disorders should also be performed.  Liver biopsy should also be considered to give a definitive diagnosis.  



It is unlikely that your liver is failing.  The tests I mentioned above will give further evaluation of the cause.  



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Thanks,

Kevin, M.D.

Member Comments

by daocmom, Mar 29, 2003 12:00AM
I agree with the doc. I had GB stone attacks during pregnancy, and 3 weeks after having the baby, I was rushed to the ER with non-stop vomiting, and pains in my lower chest/upper abdomen. Needless to say it was WAY worse then labor, and I thought I was seriously going to die. I had 4 attacks within the past 4 months. I got the ultrasound in the ER, and it was a stone in the bile duct. My enzymes were also elevated greatly.  3 weeks after the surgery, I was rushed back with another attack. Huh? I didn't have a GB, but I had stones floating around that got lodged again. I had an endoscopy and that was that. it's been two months since my GB removal, and I feel pain still, and I can't eat anything. My nausea has dimminished, so there's a plus.

by ksbjpb, Jun 14, 2003 12:00AM
To: suzann99
What was the outcome?  I am having similar test results.  Thank you.

by tealeaves, Aug 08, 2003 12:00AM
To the experts   ;0)



I too had a relatively uneventful pregnancy except for severe itching in the last two weeks.  I had no rash, no GI pain, no jaundice.  The first set of liver enzymes was WNL, so my midwife attributed the itching to something else.



Then on the day of delivery, my Blood Pressure was elevated. (up to 170/104)  the labor and delivery were VERY quick and the BP went back to normal immediately.  But my Liver enzymes were elevated that day.  (AST 53). 6 weeks post delivery it was 48  9 weeks post delivery it dropped only to 44.  (ALT is also slightly off).  I have had absolutely no symptoms since delivery, only continually elevated enzyme levels.  I am getting an abd. US. this week.



My question is, does this sound like Intrahepatic Cholestasis, or something else...? And is it unusual for enzymes to stay elevated post-delivery for this long?  Do HELLP, ICP, and Acute Fatty Liver ever cause permament damage?  And if they do but I continue to be asymptomatic, what are the long-term effects of these slightly elevated levels?



Also, what is the likelihood that these problems will reoccur in subsequent pregnancies?