Liver stiffness during pregnancy

Aims: Several life threatening but poorly understood hepatic complications are associated with pregnancy such as the HELLP syndrome, pregnancy-related cholestasis or eclampsia. Liver stiffness (LS) has evolved as a novel important diagnostic parameter that is affected by various pathologic conditions such as the degree of fibrosis, inflammation, but also intraabdominal and venous pressure. Since the intraabdominal pressure changes during pregnancy on a physiological basis, we here performed a pilot study on LS in pregnant women.

Methods: LS was measured in 35 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 35 women using the M probe except one case were the XL probe was required for reliable interquartile range. 8 women (22%) had a LS higher than 8 kPa, two 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 while all women within the second trimester had normal LS <6 kPa. No correlation was found between LS, gain of weight or BMI and no abnormal liver function tests were observed in this study population. In two cases with elevated LS, LS completely normalized after delivery. The increase in LS during the last trimester of pregnancy was related only to pregnancy, since liver congestion or cholestasis was excluded clinically by blood tests.

Conclusion: LS is significantly increased in >20% in the third trimester. According to our pilot study, physiological intraabdominal pressure seems to be a major cause of increased LS that normalizes after delivery. The influence of elevated LS on pregnancy complications remains to be elucidated.