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Related Experiment Video

Updated: Sep 17, 2025

The Use of Gas Chromatography to Analyze Compositional Changes of Fatty Acids in Rat Liver Tissue during Pregnancy

The Use of Gas Chromatography to Analyze Compositional Changes of Fatty Acids in Rat Liver Tissue during Pregnancy

Published on: March 13, 2014

Reference ranges for liver function tests in pregnancy controlling for maternal characteristics.

Hannah R Judah¹, Robert A Rigby², Mikis D Stasinopoulos²

¹Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom.

American Journal of Obstetrics and Gynecology

|July 3, 2025

Summary

Accurate liver function tests in pregnancy require adjusting for gestational age and maternal factors. This study provides new reference ranges and an online calculator for better diagnosis of liver dysfunction during pregnancy.

Keywords:

alanine aminotransferase albumin alkaline phosphatase and shape aspartate aminotransferase dispersion and shape of the distribution gamma-glutamyl transferase generalized additive model for location liver function tests maternal characteristics pregnancy reference ranges scale total bilirubin

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Area of Science:

Obstetrics and Gynecology
Maternal-Fetal Medicine
Clinical Biochemistry

Background:

Liver dysfunction affects 3% of pregnancies, increasing maternal and perinatal risks.
Accurate diagnosis relies on established reference ranges, which are often not age- or sex-adjusted.
Existing pregnancy liver function test studies lack control for maternal demographics and gestational age.

Purpose of the Study:

To establish reference ranges for liver function tests in uncomplicated pregnancies.
To adjust these ranges for gestational age and maternal demographic characteristics.
To develop an online z-score calculator for maternal liver function tests.

Main Methods:

Cross-sectional study of 3451 healthy pregnant women across four gestational age visits.
Exclusion of women with a history of liver dysfunction or adverse outcomes.
Utilized generalized additive models for location, scale, and shape (gamlss) to analyze liver function tests (ALP, ALT, AST, GGT, bilirubin, ALB) distributions.

Main Results:

Gestational age and ethnicity independently predicted liver function test distributions.
Maternal body mass index, age, parity, smoking, and weight also influenced test results.
An online z-score calculator is available at https://fetalmedicinefoundation.shinyapps.io/life/.

Conclusions:

Reference ranges for maternal liver function tests must account for gestational age and demographic factors.
Adjusting for these variables is crucial for accurate interpretation of liver function tests in pregnancy.
This approach aids in the timely diagnosis of liver dysfunction during pregnancy.