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Are elevated ALT levels common during pregnancy?

Q: My wife is 34 weeks pregnant. Recently she did some blood tests whose results are: haemoglobin (Hb): 10.8; RBC: 4.63; Bilirubin: 1.5; SGPT: 268 and SGOT: 260. I know they are very high. Is this common during pregnancy? What should we do?

A:No single liver function can quantify or define liver disease and a panel of laboratory tests profiling discrete aspects of liver function (called liver function tests) are required. An injury to liver cell (necrosis) is measured by determining aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, while the synthetic function of liver) is quantified by determining albumin level and prothrombin time. This may be affected in cirrhosis or severe hepatic disease. Measurement of bilirubin, alkaline phosphatase and GGT define obstructive liver disease (cholestasis and biliary obstruction). In normal pregnancies, alkaline phosphatase levels may be elevated upto fourfold, secondary to placental alkaline phosphatase levels. Elevations of ALT occurring during pregnancy can be a result of viral hepatitis, which can be easily diagnosed using serologic tests. Other possible causes of mild or moderate elevations of ALT are drug-induced hepatotoxicity, hyperemesis gravidarum, cholelithiasis, HELLP (hemolysis, elevated liver enzymes and low platelet count) syndrome or acute fatty liver of pregnancy. If viral hepatitis is ruled out, the elevated enzymes then have to be viewed in the clinical context of the patient and appropriate investigations done.

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