A case of isolated peripartum elevation of alkaline phosphatase in pregnancy complicated by gestational diabetes

Heazell, Alexander E P; Judge, Jatinder K.; Bhatti, Nighat

doi:10.1080/14767050600676273

Cited by 9 publications

(9 citation statements)

References 9 publications

(19 reference statements)

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“…Heazell et al 2006 reported a case of pregnancy complicated by gestational diabetes and hypertension in which extremely high elevation of bone specific isoenzyme of alkaline phosphatase was noted during labour this lead to elevation in total serum alkaline phosphatase which couldn’t be assume to arise from placenta. [5354]…”

Section: Discussionmentioning

confidence: 99%

A study of bone turnover markers in gestational diabetes mellitus

Siddiqi

Borse

Pervez

et al. 2017

Indian J Endocr Metab

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Introduction:Gestational diabetes is defined as carbohydrate intolerance resulting in hyperglycemia of variable severity with the first recognition during pregnancy. Established risk factors for gestational diabetes mellitus (GDM) are maternal age, obesity, family history of diabetes, etc. Vitamin D, parathyroid hormone (PTH), and various other hormones are known for their function in maintaining calcium and phosphorous homeostatic. Furthermore, Vitamin D, PTH serum ionized calcium, and alkaline phosphatase (ALP) have been reported to be altered with glucose homeostasis. The present study compares the bone markers in pregnant women with and without gestational diabetes.Materials and Methods:This cross-sectional study was conducted at outpatient antenatal check-up clinic and outpatient diabetic clinics at J. N. Medical College and Hospital, Aligarh. One hundred pregnant females, of which fifty with GDM and fifty without GDM, were included in the study from January 2014 to November 2015. Detailed history, physical examination, and anthropometric measurement were done. Bone turnover markers in the form of Vitamin D, parathyroid hormone, serum ionized calcium, and serum ALP were measured in pregnant women who had gestational diabetes which was compared with normal pregnant women.Results:In our study, the mean age of participate of GDM group was 28.2 ± 3 years, while the mean age group in non-GDM group was 25.44 ± 2.78 years. Ionized calcium in GDM was found to be 4.606 ± 0.354 mEq/L, while in non-GDM, it was 4.548 ± 0.384 mEq/L, P = 0.430. Vitamin D came out to be 21.80 ± 9.48 ng/ml, while it was 32.346 ± 8.37 ng/ml in non-GDM group. Serum PTH in GDM group was 71.436 ± 36.189 pg/ml and 37.168 ± 8.128 pg/ml in nondiabetic gestational group. Serum ALP in GDM group was 9.1 ± 4.56 KA U/dl and 6.98 ± 2.2 KA U/dl in nondiabetic gestational group, P - 0.0038. In GDM group, there was a significant negative linear correlation between PTH and 25-hydroxyvitamin D with research correlation coefficient r = −0.9073, P = 0; there was a significant positive linear correlation coefficient between PTH and ALP with Persian correlation coefficient r = 0.6597, P = 0; there was no statistically significant correlation between PTH and ionized calcium r = 0.1416, P = 0.3267.Conclusion:All GDM subjects should ideally be screened for serum calcium, vitamin D, PTH, ALP. If found impaired should immediately be corrected in order to prevent its adverse effects on maternal and fetal outcome. Vitamin D supplementation should ideally be initiated in all GDM females even if the above parameters are not investigated in Indian setup.

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Section: Discussionmentioning

confidence: 99%

A study of bone turnover markers in gestational diabetes mellitus

Siddiqi

Borse

Pervez

et al. 2017

Indian J Endocr Metab

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“…Although recent studies have demonstrated a statically significant correlation between the second trimester elevation in ALPt and preterm delivery [6,7] further researches are needed to confirm these results. In the remaining two reports, increased alkaline phosphatase serum levels were originating from osteal tissue (8,9). In a recently published report [10], a 22-year-old primigravida delivered a 37þ2 weeks' stillborn baby due to placental abruption.…”

Section: Commentmentioning

confidence: 95%

Markedly elevated serum alkaline phosphatase level in an uncomplicated pregnancy

Celik

Tosun

Çetinkaya

et al. 2009

The Journal of Maternal-Fetal & Neonatal Medicine

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In normal pregnancy, although maternal serum alkaline phosphatase increases and reaches the two-fold of non-pregnant serum level, above this level, hepatic, renal, osteal diseases and malignancies should be kept in mind. We report a case of 28-year-old pregnant woman with increased maternal serum level of alkaline phosphatase activity (17-fold) due to an increased level of placental isozyme. She delivered vaginally a healthy female baby. After delivery, maternal serum alkaline phosphatase activity returned to normal reference range. The aim of this case report is to show this exaggerated isozyme activity of alkaline phosphatase in pregnancy, and to differentiate it from other causes of elevated level of alkaline phosphatase.

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“…Characterization by electrophoresis should be performed to determine the origin of ALP. Several studies suggest an association between elevated ALP activity and preeclampsia [3][4][5][6], low birth weight, prematurity and placental insufficiency [7][8][9]. We present a case report of a 38-year-old female with uncontrolled chronic hypertension and extreme elevation of ALP and its association with placental dysfunction, demonstrated by placental pathology.…”

Section: Introductionmentioning

confidence: 92%

Extreme Elevation of Alkaline Phosphatase in a Pregnancy Complicated by Uncontrolled Chronic Hypertension and Its Association With Placental Pathology

et al. 2022

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Alkaline phosphatase (ALP) is an enzyme produced primarily by cells of liver, bone, kidney, small intestine and placenta, each detectable by a specific isoenzyme. It appears in maternal serum in the second trimester and increases progressively with gestational age. Review of the literature has linked markedly elevated serum ALP levels with adverse obstetric and perinatal outcomes, including preterm labor, hypertensive disorders of pregnancy and low birth weight. The exact mechanism of this association is unknown, but an overwhelming majority of literature suggests placental dysfunction as the primary cause. We describe a 38-year-old G5P2022 female who began prenatal care at 10 + 0/7. She started on labetalol 100 mg BID at 17 + 0/7. At 35 + 5/7, she had persistent severely elevated blood pressure, with ALP of 2,826 U/L. She was admitted for observation, and labetalol titrated to 300 mg BID. The maximum value of ALP was 3,429 U/L at 36 + 5/7. Serum isoenzyme assay revealed solely placental origin. Labor induction was done at 37 + 0/7 followed by delivery of a 3,315 g neonate, with a displaced clavicular fracture in the absence of shoulder dystocia. Placental pathology revealed diffuse villous edema and chorionic plate vessel with dense embedded mural thrombus. Our case represents an association between extreme elevation of ALP in pregnancy and placental dysfunction, confirmed by placental pathology. Close monitoring of the absolute value and degree of rise in ALP may hold significant clinical importance in predicting impaired placental function and ultimately in determining the timing of delivery.

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A case of isolated peripartum elevation of alkaline phosphatase in pregnancy complicated by gestational diabetes

Cited by 9 publications

References 9 publications

A study of bone turnover markers in gestational diabetes mellitus

A study of bone turnover markers in gestational diabetes mellitus

Markedly elevated serum alkaline phosphatase level in an uncomplicated pregnancy

Extreme Elevation of Alkaline Phosphatase in a Pregnancy Complicated by Uncontrolled Chronic Hypertension and Its Association With Placental Pathology

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