Extremely high levels of alkaline phosphatase and pregnancy outcome: case series and review of the literature
-
Renana Wilkof-Segev
,
Mordechai Hallak
Abstract
Objectives
To evaluate the association between extremely elevated alkaline phosphatase (ALKP) levels (above 1000 U/L) and adverse perinatal outcome.
Methods
A retrospective case series of all parturients with extremely elevated ALKP levels taken throughout pregnancy at a single university-affiliated medical center (2010–2018). Demographics and medical data were retrieved. Following literature review, previously reported similar cases were added to the cohort. We report perinatal outcome of our cohort as well as literature review.
Results
During study period 11 parturients with high ALKP were identified. Ten more cases were retrieved from PubMed search. Overall, median ALKP levels were 1880 (range 1052–4488 U/L). Reasons for evaluation were mostly nonspecific symptoms (pruritus, headache, abdominal pain) or routine obstetrical evaluation. In 10/12 (83%) cases, elevated ALKP levels were of placental origin; the rest had osteal origin. Median gestational age at delivery was 38 (range 35–41); four (19%) women had preterm delivery. Six patients (29%) had gestational diabetes mellitus and six (29%) had hypertensive disorders. Histopathology of the placenta was available in eight cases: three normal histology (38%) and five with different non-specific pathologies.
Conclusions
We report the largest case series of extremely elevated levels of ALKP in pregnancy thus far. Our data suggest association with adverse perinatal outcome.
Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Ethical approval: The research related to human use has been complied with all the relevant national regulations, institutional policies and in accordance the tenets of the Helsinki Declaration, and has been approved by the authors’ Institutional Review Board or equivalent committee (HYMC 0013-19).
References
1. Ujjawal, S, Deeksha, P, Rajendra, P. Alkaline phosphatase: an overview. Indian J Clin Biochem 2014;29:269–78. https://doi.org/10.1007/s12291-013-0408-y.Search in Google Scholar
2. Safarova, A, Bige, O, Dogan, E, Kaymaz, C. Origin and significance of extremely elevated serum alkaline phosphatase activity during normal pregnancy. Turkiye Klinikleri J Gynecol Obst 2007;17:405–8.Search in Google Scholar
3. Moawad, AH, Goldenberg, RL, Mercer, B, Meis, PJ, Iams, JD, Das, A, et al. NICHD MFMU network the preterm prediction study: the value of serum alkaline phosphatase, alpha-fetoprotein, plasma corticotropin-releasing hormone, and other serum markers for the prediction of spontaneous preterm birth. Am J Obstet Gynecol 2002;186:990–6. https://doi.org/10.1067/mob.2002.121727.Search in Google Scholar
4. Bashiri, A, Katz, O, Maor, E, Sheiner, E, Pack, I, Mazor, M. Positive placental staining for alkaline phosphatase corresponding with extreme elevation of serum alkaline phosphatase during pregnancy. Arch Gynecol Obstet 2007;275:211–4. https://doi.org/10.1007/s00404-006-0212-5.Search in Google Scholar
5. Ferianec, V, Linhartová, L. Extreme elevation of placental alkaline phosphatase as a marker of preterm delivery, placental insufficiency and low birth weight. Neuroendocrinol Lett 2011;32:154–7.Search in Google Scholar
6. Meyer, RE, Thompson, SJ, Addy, CL, Garrison, CZ, Best, RG. Maternal serum placental alkaline phosphatase level and risk for preterm delivery. Am J Obstet Gynecol 1995;173:181–6. https://doi.org/10.1016/0002-9378(95)90187-6.Search in Google Scholar
7. Rajagambeeram, R, Abu Raghavan, S, Ghosh, S, Basu, S, Ramasamy, R, Babu Murugaiyan, S. Diagnostic utility of heat stable alkaline phosphatase in hypertensive disorders of pregnancy. J Clin Diagn Res 2014;8:CC10–13. https://doi.org/10.7860/JCDR/2014/10895.5084.Search in Google Scholar
8. Vongthavaravat, V, Nurnberger, MM, Balodimos, N, Blanchette, H, Koff, RS. Isolated elevation of serum alkaline phosphatase level in an uncomplicated pregnancy: a case report. Am J Obstet Gynecol 2000;183:505–6. https://doi.org/10.1067/mob.2000.105841.Search in Google Scholar
9. Heazell, AE, Judge, JK, Bhatti, NR. A case of isolated peripartum elevation of alkaline phosphatase in pregnancy complicated by gestational diabetes. J Matern Fetal Neonatal Med 2006;19:311–3. https://doi.org/10.1080/14767050600676273.Search in Google Scholar
10. Wojcicka-Bentyn, J, Czajkowski, K, Sienko, J, Grymowicz, M, Bros, M. Extremely elevated activity of serum alkaline phosphatase in gestational diabetes: a case report. Am J Obstet Gynecol 2004;190:566–7. https://doi.org/10.1016/s0002-9378(03)00904-9.Search in Google Scholar
11. Lozo, S, Atabeygi, A, Healey, M. Extreme elevation of alkaline phosphatase in a pregnancy complicated by gestational diabetes and infant with neonatal alloimmune thrombocytopenia. Case Rep Obstet Gynecol 2016;2016:4896487. https://doi.org/10.1155/2016/4896487.Search in Google Scholar PubMed PubMed Central
12. Liu, Y, Hou, W, Meng, X, Zhao, W, Pan, J, Tang, J, et al. Early elevated alkaline phosphatase increases the risk of large-for-gestational-age birth weight in pregnant women with normal glucose tolerance. Diabetes Res Clin Pract 2018;141:209–16. https://doi.org/10.1016/j.diabres.2018.04.024.Search in Google Scholar PubMed
13. Collins, P. Serum constituents in pregnancy including four cases with elevated alkaline phosphatase levels. Clin Biochem 1981;14:98–101.10.1016/S0009-9120(81)90823-7Search in Google Scholar
14. Davis, CJ, Booth, J, Summerfield, J, Lazda, EJ, Regan, L. Grossly elevated placental derived alkaline phosphatase in pregnancy as a marker for uteroplacental vascular disease. J Obstet Gynaecol 1999;19:533–4. https://doi.org/10.1080/01443619964409.Search in Google Scholar
15. Celik, H, Tosun, M, Cetinkaya, MB, Bektab, A, Malatyalýodlu, E. Markedly elevated serum alkaline phosphatase level in an uncomplicated pregnancy. J Matern Fetal Neonatal Med 2009;22:705–7. https://doi.org/10.1080/14767050802702323.Search in Google Scholar
16. Boronkai, A, Than, NG, Magenheim, R, Bellyei, S, Szigeti, A, Deres, P, et al. Extremely high maternal alkaline phosphatase serum concentration with syncytiotrophoblastic origin. J Clin Pathol 2005;58:72–6. https://doi.org/10.1136/jcp.2003.015362.Search in Google Scholar
17. Chawanpaiboon, S, Vogel, JP, Moller, AB, Lumbiganon, P, Petzold, M, Hogan, D, et al. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health 2019;7:e37–46. https://doi.org/10.1016/s2214-109x(18)30451-0.Search in Google Scholar
18. Bulletin bulletin no. 171: management of preterm labor. Obstet Gynecol 2016;128:e155–64. https://doi.org/10.1097/AOG.0000000000001711.Search in Google Scholar PubMed
19. Practice bulletin no. 190: gestational diabetes mellitus. Obstet Gynecol 2018;131:e49–64. https://doi.org/10.1097/AOG.0000000000002501.Search in Google Scholar PubMed
20. Plows, JF, Stanley, JL, Baker, PN, Reynolds, CM, Vickers, MH. The pathophysiology of gestational diabetes mellitus. Int J Mol Sci 2018;19:3342. https://doi.org/10.3390/ijms19113342.Search in Google Scholar PubMed PubMed Central
21. Practice bulletin no. 202: gestational hypertension and preeclampsia. Obstet Gynecol 2019;133:211–14. https://doi.org/10.1097/AOG.0000000000003019.Search in Google Scholar PubMed
© 2020 Walter de Gruyter GmbH, Berlin/Boston
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Articles in the same Issue
- Frontmatter
- Review
- Methods of detection and prevention of preterm labour and the PAMG-1 detection test: a review
- Corner of Academy
- Long term alterations of growth after antenatal steroids in preterm twin pregnancies
- Original Articles – Obstetrics
- SARS-CoV-2 in pregnancy: maternal and perinatal outcome data of 34 pregnant women hospitalised between May and October 2020
- Comparison of hematological parameters and perinatal outcomes between COVID-19 pregnancies and healthy pregnancy cohort
- The effect of mask use on maternal oxygen saturation in term pregnancies during the COVID-19 process
- Risk factors for pregnancy-associated venous thromboembolism in Singapore
- Does the length of second stage of labour or second stage caesarean section in nulliparous women increase the risk of preterm birth in subsequent pregnancies?
- Reference range for C1-esterase inhibitor (C1 INH) in the third trimester of pregnancy
- Termination of pregnancy following a Down Syndrome diagnosis: decision-making process and influential factors in a Muslim but secular country, Turkey
- High dose vs. low dose oxytocin for labor augmentation: a systematic review and meta-analysis of randomized controlled trials
- Extremely high levels of alkaline phosphatase and pregnancy outcome: case series and review of the literature
- Cervical elastography strain ratio and strain pattern for the prediction of a successful induction of labour
- Original Articles – Fetus
- CD34 immunostain increases sensitivity of the diagnosis of fetal vascular malperfusion in placentas from ex-utero intrapartum treatment
- The ability of various cerebroplacental ratio thresholds to predict adverse neonatal outcomes in term fetuses exhibiting late-onset fetal growth restriction
- Obstetric and pediatric growth charts for the detection of late-onset fetal growth restriction and neonatal adverse outcomes
- Original Articles – Neonates
- Bacterial stability with freezer storage of human milk
- Protein and genetic expression of CDKN1C and IGF2 and clinical features related to human umbilical cord length
- Short Communication
- A considerable asymptomatic proportion and thromboembolism risk of pregnant women with COVID-19 infection in Wuhan, China
