The impact of elevated liver enzymes and intrahepatic cholestasis of pregnancy on the course of COVID-19 in pregnant women

Objective: This study aims to investigate the perinatal outcomes in COVID-19 pregnant women with intrahepatic cholestasis of pregnancy (ICP) and elevated liver enzymes. Methods: Present study was carried on pregnant women with COVID-19 between March 11, 2020 and August 11, 2021. Patients with liver enzyme levels higher than twice the upper limit of the reference range for Aspartate Aminotransferase (AST) and/or Alanine Transferase (ALT) were included. Cases with elevated Fasting Biliary Acid (FBA) levels were regarded as ICP. Remaining cases were used as the control group. A receiver operating characteristics (ROC) analysis was performed to assess the predictive value of ALT and AST for ICP. Results: There were a total of 1751 patients in the study period. Among them 126 had elevated liver enzymes. Nineteen of these cases had also ICP. AST and ALT values were statistically higher in the ICP group. Demographic features, clinical characteristics and perinatal outcomes were similar between the groups. The rate of ICP in pregnant women with COVID-19 was similar to the literature in this study. Although the rates of preterm delivery were higher than the current literature for both groups, study and control groups were comparable in terms of preterm delivery. The optimal cut-off values were 109.5 IU/L (specificity: 59.2%, sensitivity: 63.3%) and 89.5 IU/L (specificity: 68.4%, sensitivity: 67.3%) for ALT and AST ,respectively according to the results of the ROC analysis. Conclusion: Similar perinatal outcomes were observed between the ICP and control groups. However, relatively higher rates of maternal mortality, intensive care unit admission, neonatal intensive care unit admission, and preterm birth were observed for COVID-19 pregnant women with elevated liver enzymes compared to the previous literature. Thus, physicians dealing with pregnant women with COVID-19 should be cautious about the management of cases with elevated liver enzymes.