Managing Elevated ALT and AST during Pregnancy

As a concerned expectant mother, you may have recently received news about elevated levels of ALT (alanine aminotransferase) and AST (aspartate aminotransferase) from your blood test. These markers often indicate hepatobiliary dysfunction or disease. Understanding the implications and steps to take can help ensure the safety and health of you and your baby. Here's how you can proceed.

Understanding Elevated ALT and AST Levels

Elevated levels of ALT and AST are not uncommon and can be caused by various conditions, from non-alcoholic fatty liver disease to hepatitis, cirrhosis, or even gallbladder disease. If you're 21 weeks pregnant, there is an additional concern: cholestasis of pregnancy, which can be a complication of liver dysfunction during this time.

Potential Causes and Indications

Fatty Liver Disease: Non-alcoholic or alcoholic liver disease can elevate these enzymes. Hepatitis: Viral, autoimmune, or drug-induced types can cause liver dysfunction. Cirrhosis: Advanced liver scarring can impact enzyme levels. Liver Injury: Due to toxins, alcohol, or medications such as acetaminophen. Gallbladder Disease: Including bile duct obstruction.

Consultation and Medical Advice

The best course of action is to consult your obstetrician or primary care doctor who ordered your liver enzyme tests. They can provide a more accurate diagnosis based on your medical history and current health status. Regular monitoring is crucial, especially during pregnancy, to prevent potential complications such as eclampsia.

Mild elevations in liver function tests are not always alarming, but the underlying cause of the elevations is important. Your doctor will work to determine the exact cause, possibly ordering additional tests or consulting with a gastroenterologist. Depending on the severity and the cause, treatment options may include medication or scheduling an induction or C-section at 37 weeks to manage pregnancy complications.

Steps to Take and Recommendations

While there is no active treatment for elevated liver enzymes in pregnancy, maintaining a healthy lifestyle is essential. Follow your doctor's recommendations and attend regular appointments for monitoring. A healthy diet, proper rest, moderate exercise, and reduced stress can help support overall health during this time. Here are some specific steps you can take:

Follow Your Doctor's Recommendations

Your healthcare provider will closely monitor your liver function and general health during pregnancy. Follow their guidance closely, as they are best equipped to address any concerns specific to your pregnancy.

Consider Changing Your Healthcare Provider

If you are seeing a nurse midwife and have concerns about your elevated liver enzyme levels, it may be beneficial to seek care from an obstetrician. In some cases, a consultation with a perinatologist, a high-risk obstetrician, may also be necessary.

Nutrition and Lifestyle

A balanced diet rich in fruits, vegetables, whole grains, and lean proteins can help support liver health. Ensure you are getting adequate rest and try to manage stress through techniques such as meditation, yoga, or deep-breathing exercises. Regular moderate exercise can also be beneficial, but always consult with your healthcare provider before starting any new exercise program.

Medication and Monitoring

If necessary, your doctor may prescribe medication to help manage any underlying conditions that are contributing to your elevated liver enzymes. Regular monitoring will help catch any developing issues early, such as cholestasis, and prevent potential complications.

Conclusion

Understanding and addressing elevated ALT and AST levels during pregnancy is crucial for the health of both you and your baby. By working closely with your healthcare provider and following their recommendations, you can help ensure the best possible outcomes for your pregnancy.