THE IMPACT OF ELEVATED LIVER ENZYMES AND İNTRAHEPATIC CHOLESTASIS OF PREGNANCY ON THE COURSE OF COVID-19 IN PREGNANT WOMEN

COVID-19 in pregnancy presents unique challenges, particularly in the presence of liver dysfunction, including elevated liver enzymes and intrahepatic cholestasis of pregnancy (ICP). These conditions may worsen the disease course and contribute to adverse maternal and fetal outcomes. Objective: To evaluate the impact of elevated liver enzymes and intrahepatic cholestasis of pregnancy (ICP) on the clinical course, severity, and outcomes of COVID-19 in pregnant women. Methods: A retrospective cohort study was conducted at Punjab Medical College Faisalabad during June 2024 to October 2024. A total of 500 pregnant women diagnosed with COVID-19 were included in the study. The patients were divided into three groups: (1) COVID-19 patients with normal liver function, (2) COVID-19 patients with elevated liver enzymes, and (3) COVID-19 patients with ICP. Liver function tests, clinical outcomes, and maternal and fetal complications were analyzed. Statistical comparisons were made to assess the severity of COVID-19 symptoms and outcomes across these groups. Results: Data were collected from 500 patients, with no significant differences in age (31.4 ± 5.2 years vs. 30.8 ± 4.9 years, p = 0.24), gestational age at diagnosis (26.5 ± 4.1 weeks vs. 27.1 ± 3.8 weeks, p = 0.18), pre-pregnancy BMI (26.3 ± 4.5 vs. 25.8 ± 4.1, p = 0.15), or comorbidities such as diabetes (18% vs. 16.8%, p = 0.57) and hypertension (12% vs. 11.2%, p = 0.73). However, clinical outcomes differed significantly between the groups. The liver dysfunction group had a higher hospitalization rate (72%, 180/250 vs. 48%, 120/250, p < 0.001) and a greater proportion of ICU admissions (22%, 40/250 vs. 12.5%, 15/250, p = 0.02). Conclusion: Elevated liver enzymes and ICP in pregnant women significantly worsen the clinical course and outcomes of COVID-19. These conditions are associated with increased risks of severe maternal complications, adverse fetal outcomes, and the need for intensive medical care. Early detection and management of liver dysfunction in pregnant women with COVID-19 are critical for improving outcomes.