Z Gastroenterol 2011; 49 - V75
DOI: 10.1055/s-0031-1285211

Pregnancy increases liver stiffness and normalizes after delivery

A Kohlhaas 1, G Millonig 1, F Schütz 2, C Sohn 2, HK Seitz 3, S Mueller 1
  • 1Salem Krankenhaus, Universität Heidelberg, Medizinische Klinik, Heidelberg, Germany
  • 2Universitätsfrauenklinik Heidelberg, Heidelberg, Germany
  • 3Salem Krankenhaus, Universität Heidelberg, Heidelberg, Germany

Background: Several life threatening but poorly understood hepatic complications are associated with pregnancy such as the HELLP syndrome, pregnancy-related cholestasis, fatty liver or eclampsia. Liver stiffness (LS) has evolved as a novel important diagnostic parameter for liver disease that could be ideal for screening of hepatic complications during pregnancy. We here performed a first pilot study on LS in more than 100 pregnant women.

Methods: LS was measured in 103 pregnant women in the second and third trimester who presented during routine follow up of pregnancy. LS was measured by Fibroscan either using the M or XL probe. Besides basic gynecological data, BMI and transaminases were obtained.

Results: LS could be measured in all 103 women using the M probe except one case where the XL probe was required for reliable interquartile range. 17 women (16.5%) had a pathological LS higher than 8 kPa, four of them higher than 12.5 kPa which is regarded as cut-off value for F4 fibrosis. All women with increased LS were in the third trimester starting with week 31 while all women within the second trimester had normal LS <6 kPa. LS correlated slightly with duration of pregnancy (P<0.05), but not with gain of weight or BMI. Primary biliary or hepatic causes of increased LS were excluded by blood tests and ultrasound. No abnormal liver function tests were observed in this study population except one HELLP syndrome with elevated LS. Increased LS completely normalized after delivery in the three patients studied. Further studies on narcotized German landrace pigs suggest that not an elevated intraabdominal pressure alone but an impaired hepatic venous outflow seems to cause the increased LS during pregnancy.

Conclusion: LS is significantly increased in >20% of pregnant women in the third trimester probably due to hemodynamic reasons. Increased LS generally normalizes after delivery. Our data suggest that LS could be an important non-invasive predictor of hepatic complications during pregnancy.