Liver stiffness reversibly increases during pregnancy and independently predicts preeclampsia

World J Gastroenterol. 2018 Oct 14;24(38):4393-4402. doi: 10.3748/wjg.v24.i38.4393.


Aim: To study liver stiffness (LS) during pregnancy and its association with complications during pregnancy.

Methods: 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.

Results: 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).

Conclusion: 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.

Keywords: Hemolysis, elevated liver enzymes and low platelets syndrome; Intrahepatic cholestasis of pregnancy; Liver stiffness; Preeclampsia; Pregnancy; Pregnancy complications; Transient elastography.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Alkaline Phosphatase / blood
  • Case-Control Studies
  • Cholestasis, Intrahepatic / blood
  • Cholestasis, Intrahepatic / diagnosis*
  • Cholestasis, Intrahepatic / epidemiology
  • Elasticity Imaging Techniques / methods
  • Female
  • Germany / epidemiology
  • Gestational Age
  • Humans
  • Liver / diagnostic imaging
  • Liver / pathology*
  • Pre-Eclampsia / blood
  • Pre-Eclampsia / diagnosis*
  • Pre-Eclampsia / epidemiology
  • Pregnancy
  • Pregnancy Complications / blood
  • Pregnancy Complications / diagnosis*
  • Pregnancy Complications / epidemiology
  • Pregnancy Trimester, Third
  • Prognosis
  • Prospective Studies
  • Ultrasonography / methods


  • Alkaline Phosphatase

Supplementary concepts

  • Intrahepatic Cholestasis of Pregnancy