Investigation of the etiology of liver function test disorder detected during pregnancy and its effect on maternal-fetal adverse events

Introduction and Purpose: The liver is the largest parenchymal organ in the body and is of critical importance for many physiological processes. These include macronutrient metabolism, regulation of blood volume, immüne system, lipid and cholesterol homeostasis, and the breakdown of manydrugs and xenobiotic compounds. It also provides the energy required to perform these processes. The aim of this study was to investigate the etiological causes and fetal and maternal effects of liver enzyme elevations during pregnancy. Materials and Methods: This study included 120 patients with elevated liver enzymes during pregnancy whowere followed up at our hospital between January 1, 2014, and March 1, 2024. The control groupconsisted of 120 healthy pregnant women who did not have elevated liver enzymes during the sameperiod. Results: Out of 120 patients, 7 (5.8%) had thyroid disease before or during pregnancy, leading to hypothyroidism. Ultrasound examination revealed gallstones in 26 patients (21.7%). A significant finding was that 14 patients (11.7%) had pre-existing liver disease. The most common etiological factor causing elevated liver enzymes was intrahepatic cholestasis of pregnancy (ICP), observed in 54 patients (45%). Hyperemesis gravidarum (HG) was detected in 21 patients (17.5%). Acute fatty liver of pregnancy (AFLP) was diagnosed in 5 patients (4.2%). Two patients (1.7%) had HELLP syndrome, and two (1.7%) had preeclampsia/eclampsia. Elevated liver enzymes were attributed to gallstones detected by ultrasound in 10 patients (8.3%). Druguse was identified as the cause in 8 patients (6.7%). Two patients (1.7%) had thyroid disorders related to elevated liver enzymes. No pathology was found in 16 patients (13.3%). There were significant differences in the mode of delivery between the two groups (p: 0.017). Among patients with elevated liver enzymes, 47 (39.2%) had a normal vaginal delivery, while 73 (60.8%) had a cesarean section. In the control group, 66 (54.5%) had a normal vaginal delivery, and 55 (45.8%) had a cesarean section. Significant differences were also observed in fetal morbidity between the two groups. Five babies (4.2%) of mothers with elevated liver enzymes had morbidity, whereasno fetal morbidity was observed in the control group. Maternal mortality was not observed in either group. Conclusion: Elevated liver enzymes can be caused by physiological reasons. These pregnant women should be evaluated appropriately, and the cause should be identified quickly. Recent studies have shown that liver diseases specific to pregnancy rather than pregnancy-unrelated diseases are more likely to cause elevated liver enzymes. Due to the variability in patient groups and inclusion criteria in different studies, there are heterogeneous results regarding the etiology of liver enzyme disorders and their effects on the mother and fetus. Conditions such as ICP and HG may not cause significant mortality and morbidity in mothers and babies, while diseases like AFLP and HELLP syndrome pose a high risk of mortality and morbidity. Early diagnosis and appropriate treatment can reduce mortality and morbidity in both mothers and babies. There is a need for observational studies with larger patient cohorts on thistopic in our country. Key Words: Liver, Pregnant, Fetus, LFTs.