Fetomaternal outcome in cases of pregnancy with deranged transaminases
DOI:
https://doi.org/10.55629/pakjpathol.v37i2.1004Abstract
Objective: To evaluate the fetomaternal outcomes associated with abnormal transaminases in late pregnancy and to identify maternal factors predictive of adverse neonatal outcomes.
Material and Methods: This cross-sectional analytical study was conducted at the Department of Obstetrics & Gynecology, CMH Gujranwala, from 15-10-2025 to 14-01-2026. A total of 110 pregnant women with gestational age ≥32 weeks and elevated transaminases were included. SPSS 27 was used for data analysis. Quantitative data were expressed as mean (SD) or median (IQR), and qualitative data as frequencies and percentages. Mann-Whitney U test, independent-samples t-test, and chi-square test were used, with a p-value ≤0.05 considered significant.
Results: All participants had elevated transaminases. The median age was 28.0 years and median gestational age was 35.0 weeks. AST levels were significantly higher in women with NICU admission compared to those without (p=0.005). ALT levels were also significantly higher in women with NICU admission (p=0.003). BMI was significantly higher in women with NICU admission (p=0.006). AST was significantly associated with IUGR (p=0.014), while ALT showed no significant association (p=0.086). Preeclampsia was not significantly associated with IUGR (p=0.131) or NICU admission (p=0.110). Deranged transaminases, fatty liver disease, cesarean section, and preterm delivery were significantly associated with adverse neonatal outcomes (p<0.05).
Conclusion: Elevated maternal AST in late pregnancy is significantly associated with adverse neonatal outcomes, including IUGR and NICU admission. ALT elevation is significantly associated with NICU admission but not with IUGR. Maternal obesity, fatty liver disease, cesarean section, and preterm delivery are significant contributors to adverse outcomes.
Keywords:HELLP syndrome, Intrauterine Growth Restriction, Transaminases.
References
Butt N, Ali S, Yasmeen H, Mumtaz K. Outcomes of liver diseases in pregnant females: A study from a tertiary care medical center in Pakistan. Pak J Med Sci [Internet]. 2023 Dec. 28 [cited 2026 Jul. 1];40(3). Available from: https://www.pjms.org.pk/index.php/pjms/article/view/7670
Dinçgez B, Özgen G, Özgen L. Comparison of the predictive role of first-trimester APRI score and De Ritis ratio in intrahepatic cholestasis of pregnancy. J Contemp Med. 2024; 14(5): 222-7. Available from: https://dergipark.org.tr/tr/download/article-file/4153536
Goins EC, Wein LE, Watkins VY, Campbell AIK, Heine RP, Hughes BL, et al. Maternal and neonatal outcomes in patients with hepatitis C and intrahepatic cholestasis of pregnancy: The sum of the parts. PLoS One. 2023; 18(10): e0293030. DOI: https://doi.org/10.1371/journal.pone.0293030
Akhtar A, Sarwar A, Ebaid ME, Albalawi D, Iqbal S, Rehman FU, et al. Hepatitis E-associated determinants and diagnostic biomarkers during pregnancy and its prenatal consequences in Multan, Punjab, a tertiary care setting (Pakistan). Am J Transl Res. 2024; 16(5): 2049-58. DOI: https://doi.org/10.62347/slwm5449
Meng Z, Fang W, Meng M, Zhang J, Wang Q, Qie G, et al. Risk factors for maternal and fetal mortality in acute fatty liver of pregnancy and new predictive models. Front Med (Lausanne). 2021; 8: 719906. DOI: https://doi.org/10.3389/fmed.2021.719906 .
Sapmaz MA, Erbey S, Polat M, Kurt A, Kurt DS, Yücel KY, et al. The impact of biochemical marker levels in pregnant patients diagnosed with HELLP syndrome on predicting the progression and recovery timelines. Eur Res J. 2025; 11(5): 868-77. DOI: https://doi.org/10.18621/eurj.1681181
Bahadur A, Mundhra R, Kashibhatla J, Chawla L, Rajput R, Zaman R, et al. Clinical spectrum and outcome of pregnancy with liver diseases: A prospective study. J Family Med Prim Care. 2022; 11: 6458-63. DOI: https://doi.org/10.4103/jfmpc.jfmpc_222_22 .
Mou AD, Ali N. Investigating the prevalence and associated factors of elevated liver enzymes and dyslipidemia during pregnancy. Sci Rep. 2025; 15(1): 3967. doi: https://doi.org/10.1038/s41598-025-88798-4 .
Chilaka VN, Bashir M, Ahmed B, Konje JC. Acute liver disorders in the third trimester—AFLP, HELLP and infectious hepatitis—update on pathology, diagnosis and management. Obstet Gynaecol. 2025; 27(3): 180-96.
DOI: https://doi.org/10.1111/tog.12989
Greiner KS, Rincón M, Derrah KL, Burwick RM. Elevated liver enzymes and adverse outcomes among patients with preeclampsia with severe features. J Matern Fetal Neonatal Med. 2023; 36(1): 2160627. DOI: https://doi.org/10.1080/14767058.2022.2160627
Fondjo LA, Amoah B, Annan JJ, Adu-Gyamfi EA, Asamaoh EA. Hematobiochemical variability and predictors of new-onset and persistent postpartum preeclampsia. Sci Rep. 2022; 12(1): 3583. DOI: https://doi.org/10.1038/s41598-022-07509-5
Guszczynska-Losy M, Wirstlein PK, Wender-Ozegowska E, Kedzia M. Evaluation of predictive value of biochemical markers for adverse obstetric outcomes in pregnancies complicated by cholestasis. Ginekol Pol. 2020; 91(5): 269-76. DOI: https://doi.org/10.5603/gp.2020.0058 .
Lefizelier E, Misbert E, Brooks M, Le Thuaut A, Winer N, Ducarme G. Preterm birth and small-for-gestational-age neonates among pre-pregnancy underweight women: A case-controlled study. J Clin Med. 2021; 10(24): 5733.
DOI: https://doi.org/10.3390/jcm10245733
Ang SX, Chen CP, Sun FJ, Chen CY. Comparison of maternal and neonatal outcomes between acute fatty liver of pregnancy and hemolysis, elevated liver enzymes, and low platelets syndrome: a retrospective cohort study. BMC Pregnancy Childbirth. 2021;21(1):294. DOI: https://doi.org/10.1186/s12884-021-03761-1
Morton A. Markedly elevated liver enzymes in pregnancy: A 10-year review of cases in a tertiary maternal hospital in Brisbane, Australia. Obstet Med. 2025; 18(1): 29-32. DOI: https://doi.org/10.1177/1753495x231226339
Tesfa D, Tadege M, Digssie A, Abebaw S. Intrauterine growth restriction and its associated factors in South Gondar zone hospitals, Northwest Ethiopia, 2019. Arch Public Health. 2020; 78: 89. DOI: https://doi.org/10.1186/s13690-020-00475-2
Yang L, Feng L, Huang L, Li X, Qiu W, Yang K, et al. Maternal factors for intrauterine growth retardation: Systematic review and meta-analysis of observational studies. Reprod Sci. 2023; 30(6): 1737-45. DOI: https://doi.org/10.1007/s43032-021-00756-3
Rogozińska E, Marlin N, Jackson L, Rayanagoudar G, Ruifrok AE, Dodds J, et al. Effects of antenatal diet and physical activity on maternal and fetal outcomes: individual patient data meta-analysis and health economic evaluation. Health Technol Assess. 2017; 21(41): 1-158. DOI: https://doi.org/10.3310/hta21410
Nairz J, Messner A, Kiechl SJ, Winder B, Hochmayr C, Egger AE, et al. Determinants of non-alcoholic fatty liver disease in young people: maternal, neonatal, and adolescent factors. PLoS One. 2024; 19(2): e0298800.
DOI: https://doi.org/10.1371/journal.pone.0298800
Zhang Y, Sheng C, Wang D, Chen X, Jiang Y, Dou Y, et al. High-normal liver enzyme levels in early pregnancy predispose the risk of gestational hypertension and preeclampsia: a prospective cohort study. Front Cardiovasc Med. 2022; 9: 963957. DOI: https://doi.org/10.3389/fcvm.2022.963957
Sun Q, Lao TT, Du M, Xie M, Sun Y, Bai B, et al. Chronic maternal hepatitis B virus infection and pregnancy outcome: A single center study in Kunming, China. BMC Infect Dis. 2021;21(1):253. DOI: https://doi.org/10.1186/s12879-021-05946-7
Sultana R, Humayun S, Manzoor S, Humayun S. Pregnancy outcome in acute viral hepatitis E. Ann King Edw Med Univ. 2022; 28(1): 33-8. DOI: https://doi.org/10.21649/akemu.v28i1.5006
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Amel Amjad Buttar, Abida Ashraf, Amber Ijaz, Huma Ijaz, Assma Majeed
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Readers may “Share-copy and redistribute the material in any medium or format” and “Adapt-remix, transform, and build upon the material”. The readers must give appropriate credit to the source of the material and indicate if changes were made to the material. Readers may not use the material for commercial purpose. The readers may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
