Maternal amylase, lipase, lactate dehydrogenase, creatine kinase levels at preterm delivery, and the effect of tocolysis

Abstract

Background/Aim: Preterm labor is one of the main obstetric problems and the leading cause of neonatal mortality and morbidity. Some pregnant women at risk of preterm labor receive tocolytic therapy, but the agents used can affect maternal blood parameters and enzyme levels. Physiological changes that occur during pregnancy may cause changes in enzymatic activities. Maternal amylase, lipase, lactate dehydrogenase (LDH), and creatine kinase (CK) levels should be followed throughout pregnancy to assess any increase. This study aimed to examine maternal amylase, lipase, creatine kinase, and lactate dehydrogenase levels in pregnant women who gave term and preterm birth and determine the physiological changes that may occur with gestational age and tocolysis. Methods: The records of patients over their 24th gestational week who gave birth at the Gynecology and Obstetrics Department of Okmeydani Training and Research Hospital between July-December 2018 were reviewed in this retrospective cohort study. Their clinical findings, maternal and obstetric outcomes were noted. A total of 548 pregnant women were included in the study, who were divided into three groups: Group 1- Preterm delivery without tocolysis, Group 2- Preterm delivery with tocolysis, Group 3- Term delivery Results: The maternal age, gravidity, history of abortion, fetal gender, amylase, and lipase values were similar between the groups (p>0.05 for all), while delivery types and cesarean section indications significantly differed (p=0.009, and p<0.001 respectively). The mean LDH value of Group 2 was significantly higher than those of Groups 1 and 3 (p=0.006, and p=0.024, respectively). The mean CK value of Group 3 was also higher than those of Groups 1 and 2 (p=0.021, and p<0.001, respectively), and that of Group 1 was significantly higher than that of Group 2 (p=0.021). LDH, amylase, lipase, and CK levels were not correlated with gestational age and fetal weight in the premature birth groups. In Group 3, a significant negative correlation was observed between fetal weight and amylase (r = -0.136 P=0.02). Among all patients, gestational week and LDH (r = -0.117, P=0.006) and fetal weight and LDH (r = -0.107, P=0.012) were negatively correlated, while fetal weight and lipase (r = 0.095 P=0.027) and gestational week and CK were positively correlated (r = 0.085 P=0.047) (Table 2, Figures 2 and 3). Conclusion: Maternal enzyme levels may change with gestational week and as fetal weight increases. It is necessary to differentiate between pathological and physiological changes. These enzymes are also affected by tocolytic agents. Since our study was conducted in a healthy pregnant group without any systemic diseases, we think that the changes caused by gestational age and fetal weight gain are physiologically acceptable. However, any sudden elevation in these enzymes should be thoroughly investigated throughout pregnancy.

Keywords

• Amylase
• Creatine kinase
• Lactate dehydrogenase
• Lipase
• Nifedipine
• Tocolysis

References

1. 1. Mali P. Pancreatitis in pregnancy: etiology, diagnosis, treatment, and outcomes. Hepatobiliary Pancreat Dis Int. 2016 Aug;15(4):434-8. doi: 10.1016/s1499-3872(16)60075-9.
2. 2. Mongelli M, Kwan Y, Kay LL, Hjelm M, Rogers MS. Effect of labour and delivery on plasma hepatic enzymes in the newborn. J Obstet Gynaecol Res. 2000 Feb;26(1):61-3. doi: 10.1111/j.1447-0756.2000.tb01203.x.
3. 3. De Guingand DL, Ellery SJ, Davies-Tuck ML, Dickinson H. Creatine and pregnancy outcomes, a prospective cohort study in low-risk pregnant women: study protocol. BMJ Open. 2019 Jan 15;9(1):e026756. doi: 10.1136/bmjopen-2018-026756.
4. 4. Leal-Júnior CC, Amorim MMR, Souza GFA, Lima AKS, Souza ASR. Effectiveness of an oral versus sublingual loading dose of nifedipine for tocolysis. Int J Gynaecol Obstet. 2020 Mar;148(3):310-315. doi: 10.1002/ijgo.13067. Epub 2019 Dec 11.
5. 5. ACOG Committee on Practice Bulletins. American College of Obstetricians and Gynecologist. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologist. Number 43, May 2003. Management of preterm labor. Obstet Gynecol. 2003 May;101(5 Pt 1):1039-47. doi: 10.1016/s0029-7844(03)00395-8.
6. 6. Rohleder N, Nater UM. Determinants of salivary alpha-amylase in humans and methodological considerations. Psychoneuroendocrinology. 2009 May;34(4):469-85. doi: 10.1016/j.psyneuen.2008.12.004. Epub 2009 Jan 19.
7. 7. Mitura K, Romanczuk M. Ruptured ectopic pregnancy mimicking acute pancreatitis. Ginekol Pol. 2009 May;80(5):383-5.
8. 8. Nater UM, Rohleder N. Salivary alpha-amylase as a non-invasive biomarker for the sympathetic nervous system: current state of research. Psychoneuroendocrinology. 2009 May;34(4):486-96. doi: 10.1016/j.psyneuen.2009.01.014. Epub 2009 Feb 26.

9. 9. Guglielminotti J, Dehoux M, Mentré F, Bedairia E, Montravers P, Desmonts JM, et al. Assessment of salivary amylase as a stress biomarker in pregnant patients. Int J Obstet Anesth. 2012 Jan;21(1):35-9. doi: 10.1016/j.ijoa.2011.09.008. Epub 2011 Nov 26.
10. 10. Nava S, Bocconi L, Zuliani G, Kustermann A, Nicolini U. Aspects of fetal physiology from 18 to 37 weeks' gestation as assessed by blood sampling. Obstet Gynecol. 1996 Jun;87(6):975-80. doi: 10.1016/0029-7844(96)00056-7.
11. 11. van Vliet EO, Schuit E, Heida KY, Opmeer BC, Kok M, Gyselaers W, et al. Nifedipine versus atosiban in the treatment of threatened preterm labour (Assessment of Perinatal Outcome after Specific Tocolysis in Early Labour: APOSTEL III-Trial). BMC Pregnancy Childbirth. 2014 Mar 3;14:93. doi: 10.1186/1471-2393-14-93.
12. 12. Takahashi T, Minakami H, Tamada T, Sato I. Hyperamylasemia in response to ritodrine or ephedrine administered to pregnant women. J Am Coll Surg. 1997 Jan;184(1):31-6.
13. 13. Nakajima Y, Masaoka N. Evaluation of creatine kinase, lactate dehydrogenase, and amylase concentrations in umbilical blood of preterm infants after long-term tocolysis. Obstet Gynecol Int. 2014;2014:278379. doi: 10.1155/2014/278379.
14. 14. Tsatsaris V, Papatsonis D, Goffinet F, Dekker G, Carbonne B. Tocolysis with nifedipine or beta-adrenergic agonists: a meta-analysis. Obstet Gynecol. 2001 May;97(5 Pt 2):840-7. doi: 10.1016/s0029-7844(00)01212-6.
15. 15. Xydas NP, May JH, Henson MC. Maternal serum amylase and lipase profiles in pregnancy: determinations in both once-sampled and multisampled patient cohorts. South Med J. 1996 Feb;89(2):199-203. doi: 10.1097/00007611-199602000-00008.
16. 16. Cruciat G, Nemeti G, Goidescu I, Anitan S, Florian A. Hypertriglyceridemia triggered acute pancreatitis in pregnancy - diagnostic approach, management and follow-up care. Lipids Health Dis. 2020 Jan 4;19(1):2. doi: 10.1186/s12944-019-1180-7.
17. 17. Chase CW, Barker DE, Russell WL, Burns RP. Serum amylase and lipase in the evaluation of acute abdominal pain. Am Surg. 1996 Dec;62(12):1028-33.
18. 18. Karsenti D, Bacq Y, Bréchot JF, Mariotte N, Vol S, Tichet J. Serum amylase and lipase activities in normal pregnancy: a prospective case-control study. Am J Gastroenterol. 2001 Mar;96(3):697-9. doi: 10.1111/j.1572-0241.2001.03607.x.
19. 19. Ordorica SA, Frieden FJ, Marks F, Hoskins IA, Young BK. Pancreatic enzyme activity in pregnancy. J Reprod Med. 1991 May;36(5):359-62.
20. 20. Weiner CP, Sipes SL, Wenstrom K. The effect of fetal age upon normal fetal laboratory values and venous pressure. Obstet Gynecol. 1992 May;79(5(Pt 1)):713-8.
21. 21. Ozgu-Erdinc AS, Cavkaytar S, Aktulay A, Buyukkagnici U, Erkaya S, Danisman N. Mid-trimester maternal serum and amniotic fluid biomarkers for the prediction of preterm delivery and intrauterine growth retardation. J Obstet Gynaecol Res. 2014 Jun;40(6):1540-6. doi: 10.1111/jog.12371.
22. 22. Borna S, Mirzaie F, Abdollahi A. Mid-trimester amniotic fluid C-reactive protein, ferritin and lactate dehydrogenase concentrations and subsequent risk of spontaneous preterm labour. Aust N Z J Obstet Gynaecol. 2009 Aug;49(4):400-3. doi: 10.1111/j.1479-828X.2009.01019.x.
23. 23. Horjus DL, Bokslag A, Hutten BA, van den Born BH, Middeldorp S, Vrijkotte TGM. Creatine kinase is associated with blood pressure during pregnancy. J Hypertens. 2019 Jul;37(7):1467-1474. doi: 10.1097/HJH.0000000000001900.
24. 24. Matsuda Y, Nagayoshi Y, Kirihara N. Evaluation of creatine kinase level during long-term tocolysis. J Perinat Med. 2002;30(6):476-9. doi: 10.1515/JPM.2002.074.
25. 25. Adamcová M, Kokstein Z, Palicka V, Vávrová J, Podholová M, Kost'ál M. Cardiac troponin T in neonates after acute and long-term tocolysis. Biol Neonate. 2000 Nov;78(4):288-92. doi: 10.1159/000014281.