Serum Aspartate Transaminase and Alanine Transaminase Levels of Pre-Eclamptic Women Attending Victoria Chitepo Provincial Hospital from 2024 to 2025

Abstract

Pre-eclampsia remains a principal driver of maternal and perinatal mortality in low and-middle-income countries like Zimbabwe. A critical indicator of disease severity and progression towards severe complications, including HELLP syndrome, is hepatic involvement, which manifests biochemically as elevated serum aspartate transaminase (AST) and alanine transaminase (ALT). However, there is a significant scarcity of local, context-specific data characterizing this biochemical impact within Zimbabwe's provincial referral hospitals. This study aimed to evaluate the impact of pre-eclampsia on liver function by prospectively assessing the serum levels of AST and ALT among pregnant women attending Victoria Chitepo Provincial Hospital between 2024 and 2025. The goal was to determine the extent of hepatic involvement and its correlation with disease severity. The study utilized a prospective cross-sectional design conducted at Victoria Chitepo Provincial Hospital, Zimbabwe's chief referral hospital for Manicaland province. A total of 185 pregnant women, selected via purposive sampling for a pre-eclampsia diagnosis after 20 weeks of gestation followed by random sampling, were included in the final analysis. Key exclusion criteria included pre-existing liver disease and chronic hypertension. Data were collected on sociodemographic characteristics, gestational age, and clinical severity, with serum AST and ALT levels analysed as the primary outcome variables. The analysis of the 185-woman cohort revealed a high overall prevalence of hepatic enzyme derangement, with 37.3% of all participants exhibiting at least one elevated enzyme.1 A significant discrepancy was observed between the two enzymes: AST elevation (>40 IU/L) was three times more prevalent at 35.7% compared to the more liver-specific ALT elevation (>48 IU/L) at 11.9%. Sociodemographic analysis identified residential area as the most potent determinant of hepatic stress; the 'Rural' cohort demonstrated the highest prevalence of both elevated AST (57.1%) and elevated ALT (21.4%). Statistical analysis confirmed a strong, significant positive correlation between AST and ALT levels (r = 0.642, p <.001) and a weak, yet statistically significant, negative correlation between gestational age and both AST (r = -0.203) and ALT (r = -0.176), suggesting a link between early-onset pre-eclampsia and more severe hepatic injury. The high prevalence of hepatic enzyme elevation, particularly the stark "urban-rural divide," provides quantitative evidence of a major health inequity. This suggests that rural patients presenting for referral at VCPH often have a more advanced and severe disease state at the time of diagnosis. The study also identified a "biochemical-clinical disconnect," in which measurable biochemical risk (i.e., elevated AST) can precede a formal "Severe" clinical diagnosis, implying that current clinical criteria may be lagging indicators of underlying organ damage. Based on these findings, it is recommended that routine AST/ALT screening be adopted for all patients diagnosed with pre-eclampsia at VCPH, not only those deemed clinically severe, to enable earlier intervention. Public health resources, including point-of-care testing and patient transport vouchers, should be strategically prioritized for high-risk 'Rural' and 'Urban High Density' populations to mitigate access-to-care barriers. Further longitudinal, multi-centre studies are recommended to confirm these findings, mitigate selection bias, and assess the prognostic value of enzyme velocity.