Published online Oct 14, 2018. doi: 10.3748/wjg.v24.i38.4393
Peer-review started: August 1, 2018
First decision: August 24, 2018
Revised: September 20, 2018
Accepted: October 5, 2018
Article in press: October 5, 2018
Published online: October 14, 2018
To study liver stiffness (LS) during pregnancy and its association with complications during pregnancy.
In this observational, diagnostic study, 537 pregnant women were prospectively enrolled at the Department of Obstetrics and Gynecology, University hospital Heidelberg and Salem Medical Center. LS was measured using the Fibroscan device (Echosens, Paris) in all women and in 41 cases 24 h after delivery. Clinical and morphological data were recorded and abdominal ultrasound and standard laboratory tests were performed. No complications were observed in 475 women (controls) while preeclampsia and intrahepatic cholestasis of pregnancy (ICP) developed in 22 and 40 women, respectively.
In controls, LS increased significantly from initially 4.5 ± 1.2 kPa in the second trimester to 6.0 ± 2.3 kPa (P < 0.001) in the third trimester. In the third trimester, 41% of women had a LS higher than 6 kPa. Elevated LS in controls was significantly correlated with alkaline phosphatase, leukocytes, gestational age and an increase in body weight and body mass index (BMI). In women with pregnancy complications, LS was significantly higher as compared to controls (P < 0.0001). Moreover, in multivariate analysis, LS was an independent predictor for preeclampsia with an odds ratio of 2.05 (1.27-3.31) and a cut-off value of 7.6 kPa. In contrast, ICP could not be predicted by LS. Finally, LS rapidly decreased in all women within 24 h after delivery from 7.2 ± 3.3 kPa down to 4.9 ± 2.2 kPa (P < 0.001).
During pregnancy, LS significantly and reversibly increases in the final trimester of pregnant women without complications. In women with preeclampsia, LS is significantly elevated and an independent non-invasive predictor.
Core tip: Liver stiffness (LS) was measured by transient elastography during pregnancy in 537 healthy pregnant women without complications and in 62 women with pregnancy complications such as preeclampsia or intrahepatic cholestasis of pregnancy. Our results show that LS increases during pregnancy to levels above 6 kPa even in women without pregnancy complications and rapidly normalizes within 24 h after delivery. LS was significantly elevated in women with preeclampsia and, moreover, an independent predictor for preeclampsia in multivariate analysis. In conclusion, LS could be a novel non-invasive screening parameter to identify pregnant women at risk for complications of pregnancy.