Association of antenatal antithrombin activity with perinatal liver dysfunction: A prospective multicenter study

Background and Aim Liver dysfunction with decreased antithrombin activity (AT) and/or thrombocytopenia is life-threatening in pregnant women. Whether AT is clinically useful for prediction of liver dysfunction remains unclear. Methods A total of 541 women were registered prospectively at gestational week 34.7 (20.0 – 41.4) with available data on antenatal AT and platelet count (PLC). Results Liver dysfunction defined as serum AST  >  45 IU/L concomitant with lactate dehydrogenase (LDH)  >  400 IU/L occurred in five women antenatally (≤ 2 weeks before delivery) and in 17 women postpartum (within 1 week postpartum). Median (5th – 95th) antenatal value was 85 (62 – 110)% for AT and 202 (118 – 315) × 109/L for PLC in the 541 women, and was significantly lower in women with than without perinatal liver dysfunction; 75 (51 – 108) vs. 86 (62 – 110)% and 179 (56 – 244) vs. 203 (121 – 316) × 109/L, respectively. Nineteen (86%) women with liver dysfunction showed AT  ≤  62% or thrombocytopenia (PLC  ≤  118 × 109/L) perinatally, but five lacked thrombocytopenia throughout the perinatal period. The best cut-off (AT, 77%; PLC, 139 × 109/L) suggested by receiver operating characteristic curve gave antenatal AT and PLC sensitivity of 59% and 41% with positive predictive value (PPV) of 8.6% and 14%, respectively, and combined use of AT and PLC improved sensitivity to 73% (16/22) with PPV of 9.2% for prediction of perinatal liver dysfunction. Conclusions Reduced AT not accompanied by thrombocytopenia can precede liver dysfunction. Clinical introduction of AT may enhance safety of pregnant women. This article is protected by copyright. All rights reserved.