Liver stiffness reversibly increases during pregnancy and independently predicts preeclampsia

Figure 1 Study design. ICP: Intrahepatic cholestasis of pregnancy.

Figure 2 Liver stiffness increased almost exclusively in the third trimester of normal pregnancy. A: Mean LS as a function of gestational week (9 to 42) of healthy pregnant women without pregnancy complications. Displayed is the mean LS for every gestational week with 95% confidence bands from standard deviation and the nonlinear regression function from a Boltzmann fit with y = 7.0 - 2.67 × (1/(1 + exp((gest.week - 32)/3.7))). From gestational week 26 on LS starts to increase and settles at a plateau of 6.7 kPa at week 39. B: LS in healthy pregnant women without pregnancy complications such as preeclampsia or intrahepatic cholestasis dependent on the trimester of pregnancy where the measurement took place. LS is significantly increased in women in the third trimester of pregnancy compared to women in the first or second trimester. No significant difference between LS in the first and second trimester was observed. LS: Liver stiffness. ^aP < 0.05; ^bP < 0.01; ^cP < 0.001.

Figure 3 Liver stiffness in women without pregnancy complications and a measurement in the third trimester compared to liver stiffness in women with preeclampsia and intrahepatic cholestasis of pregnancy. LS is significantly higher in preeclampsia (17.9 ± 20.7 kPa, P < 0.0001) and cholestasis (6.9 ± 2.1 kPa, P < 0.0001) even when compared to controls in the third trimester (6.0 ± 2.3 kPa), where LS increases also in uncomplicated pregnancies. Two women with preeclampsia had LS measurements of 75 kPa, which are not shown for design reasons. LS: Liver stiffness; ICP: Intrahepatic cholestasis of pregnancy.

Figure 4 Mean liver stiffness and standard deviation in the third trimester of pregnancy. Twenty-four hours after delivery in healthy pregnant women without complications (controls, n = 26) and in non-control women with intrahepatic cholestasis of pregnancy (n = 9) and preeclampsia (n = 6). LS decreases significantly in both groups after delivery. All controls decreased after delivery to values < 6 kPa while two women with ICP and one woman with preeclampsia stayed above the 6 kPa level. ^cP < 0.001 and ^aP < 0.05. LS: Liver stiffness.