Understanding ALT, Bile Salts, and Liver Health in Pregnancy

Your liver is like a busy little factory that helps clean and sort the goodies in your blood. It’s always working—taking out the trash (toxins), recycling leftovers (like hormones), and making helpful things (like bile to help you digest fats).

There’s a little worker in that factory called ALT (alanine aminotransferase—but we’ll just call him “Al the Tester”). Al usually stays inside the liver doing his job. But if the liver is stressed or inflamed, Al might slip out and show up in the blood. If we find Al there, it’s a clue that the liver is waving a little red flag saying, “Hey! I’m not feeling great right now!”

Now let’s talk about bile and bile salts! Bile is like dish soap your liver makes to help digest fats. Bile salts are like tiny bubbles in that dish soap. If the liver is struggling and bile isn’t draining properly, those bubbles (bile salts) can back up into your bloodstream. This can make you itchy or uncomfortable and can even affect your baby.

So what do the numbers mean when we test bile salts?

• Less than 10: The sink is draining well! If your labs return with anything under 10, you’re doing great.

• 10 to 39: The sink is draining slowly. We’re paying closer attention and may test more often.

• 40 and above: The sink is clogged. This confirms a condition called intrahepatic cholestasis of pregnancy (ICP), and your provider will talk about medicine and possibly delivering your baby early.

Most people hear that ICP causes itching, especially on the hands and feet at night. But not everyone feels itchy. Some people feel a tingling, prickling, or crawling sensation—especially on the soles of their feet at night. That’s still a signal from your body that something may be worth watching, even if it's not the classic 'itch.'

Here’s what to remember:

• A bile salt level below 10 is in the normal range—yay!

• If you start to feel itchy, especially at night, let your care team know.

• It’s possible to have liver stress with a number below 10. We want to support your liver with nutrition and herbs.

• Even tingling is worth watching, so checking again later is always okay.
  

  Your care team is here to keep you and your baby safe and comfy.
  
  Your body is amazing at sending clues. We’re just here to help read them together.