Comparative Study between Pregnant and Non-Pregnant Women Regarding Variation of Liver Function Tests: Assessment of Health Literacy
Authors: Othman Amina I. B. , Elsherbini Dalia M. A. , Eittah Hayam F. A. , Hakami Manal S. , Mohammed Badria M. A. 
Published: May 2022

Context: Pregnancy is associated with normal physiological adaptive changes. Biochemical parameters reflect these changes and are distinct from the non-pregnant state. Low levels of health literacy have been shown to result in less healthy choices, riskier behavior, poorer health, less self-management, and more hospitalization among that category of adult patients. Aim: The study aimed to examine the effect of pregnancy on liver function tests among pregnant women during various trimesters of pregnancy and compare with non-pregnant and determine the patients' level of health literacy regarding the variation of liver function tests among those patients.

Methods: A descriptive cross-sectional design was used to achieve the study aim. A random sample of 65 women was selected from an outpatient clinic in the maternity hospital; 54 out of them were pregnant women. Three tools were used to collect data, socio-demographic and clinical data assessment sheet; assessment of liver function tests by Cobas c 311; and health literacy management scale. Results: The sample's age range was between 20-40 years. This study revealed that; serum albumin levels decreased from the first trimester (3.7-4.7), and this decrease became progressively more accentuated as the pregnancy advanced (3.35-4.36 decreased significantly to 3.19-3.81). There was no significant decrease in serum AST between pregnant and non-pregnant women, but there was a significant decrease in ALT in pregnant women compared with non-pregnant women (11.90 Vs. 8.60 at p 0.017). In the current study, Serum alkaline phosphatase (ALP) was significantly higher (P˂0.0001) during the third trimester (63-171) compared with the second trimester (33-137), and the first trimester (36-129), and with the control group (48-122). Finally, it was found that a significant decrease in total serum bilirubin concentrations during the second (0.11-0.38) and third trimesters (0.12-0.42) compared to control (0.11-1.57) and the first trimester (0.12-0.85). Moreover, most of the studied sample has a low level of health literacy for all subscales and the total scores.

Conclusion: During normal pregnancy, most values of liver function tests remain below the normal upper limits compared to non-pregnant women. Any increase in serum ALT and AST activity levels and serum bilirubin should be considered pathologic and prompt for further evaluation. Moreover, most of the studied sample has a low level of health literacy for all subscales and the total scores. The study recommended that the liver function tests should be routinely investigated during pregnancy to outline any pathologic changes. Focusing on the nurse's role, she should emphasize increasing the patient's level of health literacy regarding the variation of liver function tests. So, it is a must for nurses to develop many skills to enable them to function for this category of patients with low health literacy levels. Also, those patients should be equipped with information-seeking behavior, decision-making abilities, and problem-solving approaches along their health and illness continuum.