Association of Deranged Liver Enzymes in Pregnancy with Fetal Outcomes in the Post-COVID Era
DOI:
https://doi.org/10.51253/pafmj.v74i4.11144Keywords:
COVID-19 infection, Cholestasis of pregnancy, Liver function tests, Pregnancy.Abstract
Objective: To assess the association of feto-maternal outcomes of patients with deranged Liver Function Tests having a history of COVID-19 infection.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Gynaecology and Obstetrics, Combined Military Hospital, Rawalpindi and Quetta Pakistan, from Aug 22 to April 2023.
Methodology: A sample of one hundred and forty-six pregnant patients fulfilling the inclusion criteria were enrolled using a consecutive sampling technique. Various investigations were performed to confirm pregnancy-associated liver disease and rule out other causes of hepatitis. Patients with known diabetes, liver disease, renal disease and cancer before the current pregnancy were excluded. Patients were followed up until delivery, and their fetal and maternal outcomes were assessed.
Results: Among 2409 pregnant patients presenting during the study time, 146(6.06%) patients presented with deranged Liver Function Tests. Fetal adverse outcome (Meconium staining of liquor or Intrauterine Device was observed in 55/146(37.7%) cases. Of the 146 participants, four deaths occurred, resulting in a death rate of 4/146(2.74%). Significant differences were observed in haemoglobin levels and platelet counts between the surviving and deceased groups. Significant associations were found between survival outcomes and history of COVID-19 infection, COVID-19 in current pregnancy, and hypertension. However, none of the variables emerged as significant predictors of survival in the regression analysis.
Conclusion: Lower haemoglobin levels, lower platelet counts, history of COVID-19 infection, COVID-19 in current pregnancy, and hypertension were associated with poorer outcomes in pregnant patients with deranged Liver Function Tests.
Downloads
References
Kulkarni AV, Kumar P, Tevethia HV, Premkumar M, Arab JP, Candia R, et al. Systematic review with meta‐analysis: liver manifestations and outcomes in COVID‐19. Alimen Pharmacol Therapeut 2020;52(4):584-599. https://doi.org/10.1111/apt.15916
Parohan M, Yaghoubi S, Seraji A. Liver injury is associated with severe coronavirus disease 2019 (COVID‐19) infection: a systematic review and meta‐analysis of retrospective studies. Hepatol Res 2020 Aug; 50(8): 924-935.
https://doi.org/10.1111/hepr.13510
Çelik S, Çalışkan CS, Çelik H, Güçlü M, Başbuğ A. Predictors of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy. Ginekol Polska 2019; 90(4): 217-22.
https://doi.org/10.3390/jcm12134407
Piechota J, Jelski W. Intrahepatic cholestasis in pregnancy: review of the literature. J Clin Med 2020; 9(5): 1361.
https://doi.org/10.3390/jcm9051361
Ovadia C, Williamson C. Intrahepatic cholestasis of pregnancy: are we expecting too much from ursodeoxycholic acid?–Authors' reply. Lancet Gastroenterol Hepatol 2021; 6(11): 886-887.
https://doi.org/10.1016/S2468-1253(21)00304-6
Gruszczyńska-Losy M, Mostowska A, AdamczakŁukasz, Jagodziński P, Wender-Ożegowska E, Kędzia M. Association of ABCB4 and ABCB11 nucleotide variants with intrahepatic cholestasis of pregnancy. J Med Sci 2019; 88(4): 209-217.
https://doi.org/10.20883/medical.388
Yule CS, Holcomb DS, Kraus AC, Brown CE, McIntire DD, Nelson DB. et al. Cholestasis: A prospective study of perinatal outcomes and time to symptom improvement. Am J Perinatol 2020; 38(05): 414-420. https://doi.org/10.1055/s-0040-1717076
Jamil S, Mahmood N, Mahmood K, Imran R, Anwaar I, Anwaar M. et al. Abnormal Liver Function Test during Pregnancy also Determine the Maternal and Fetal Outcomes. Pak J Med Health Sci 2022 26; 16(02): 244. https://doi.org/10.53350/pjmhs22162244
Wei W, Hu YY. Expression of hypoxia-regulated genes and glycometabolic genes in placenta from patients with intrahepatic cholestasis of pregnancy. Placenta 2014; 35(9): 732-736.
https://doi.org/10.1080/14767058.2020.1714583
Morrison MA, Chung Y, Heneghan MA. Managing hepatic complications of pregnancy: practical strategies for clinicians. BMJ Open Gastroenterol 2022; 9(1): e000624.
http://dx.doi.org/10.1136/bmjgast-2021-000624
Guarino M, Cossiga V, Morisco F. The interpretation of liver function tests in pregnancy. Best Prac Res Clin Gastroenterol 2020; 44: 101667.
https://doi.org/10.1016/j.bpg.2020.101667
Rajora P, Kumar M, Grover S. Pregnancy And Liver Disease: A Challenging Issue. Ann Roman Soc Cell Biol 2021; 25(6): 880-891.
Gao XX, Ye MY, Liu Y, Li JY, Li L, Chen W, et al. Prevalence and risk factors of intrahepatic cholestasis of pregnancy in a Chinese population. Sci Rep 2020; 10(1): 16307.
https://doi.org/10.1038/s41598-020-73378-5
Brady CW. Liver disease in pregnancy: what's new. Hepatol Commun 2020; 4(2): 145-156.
https://doi.org/10.1002/hep4.1470
Choudhary A, Singh V, Bharadwaj M. Maternal and neonatal outcomes in pregnant women with SARS-CoV-2 infection complicated by hepatic dysfunction. Cureus 2022; 14(5): 25347.
https://doi.org/10.7759/cureus.25347
Can E, Oğlak SC, Ölmez F. Abnormal liver function tests in pregnant patients with COVID-19—a retrospective cohort study in a tertiary center. Ginekol Polska 2022; 93(2): 151-157.
https://doi.org/10.5603/GP.a2021.0182
Wu K, Yin B, Li S, Zhu X, Zhu B. Prevalence, risk factors and adverse perinatal outcomes for Chinese women with intrahepatic cholestasis of pregnancy: a large cross-sectional retrospective study. Ann Med 2022; 54(1): 2965-2973.
https://doi.org/10.1080/07853890.2022.2136400
Chen Y, Xu Z, Wang P, Li XM, Shuai ZW, Ye DQ, et al. New-onset autoimmune phenomena post-COVID-19 vaccination. Immunology 2022; 165(4): 386-401.
https://doi.org/d10.1111/imm.13443
Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Eng J Med 2020; 383(27): 2603-2615.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Islam Bano, Sofia Naz, Munnaza Andleeb, Rozina khanum, Zoha Nisar
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.