Many standard texts present the concept that pregnancy does not alter hepatic function. Refutation of this thesis is suggested by the fact that elevation of serum levels of alkaline phosphatase and abnormality of sulfobromophthalein (BSP) tests are common during the last trimester of pregnancy. The probable reason for such selective hepatic impairment was recently described by Mueller and Kappas1 after investigation of the influence of natural estrogens on liver function. Estradiol and estriol were administered to 31 patients, and the effects of these agents were evaluated by means of liver-function tests and percutaneous liver biopsy. Serum alkaline phosphatase values became abnormal in nearly 50% of estrogen-treated patients, and impairment of BSP disposal (with levels as high as 30% retention) occurred in nearly all patients. The abnormal responses invariably receded when estrogen treatment ended. Other liver-function tests remained unchanged from control values. Percutaneous biopsies of the liver were obtained during
PREGNANCY, ESTROGENS AND HEPATIC IMPAIRMENT. JAMA. 1965;191(8):670. doi:10.1001/jama.1965.03080080060020
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