Postpartum ALT/AST Flare


I recently gave birth in April and went for my HBV follow up both in May and most recently July 1.

I’m 35
My usual AST ranges from 16-24 and my ALT is usually around 12-16

Recent results:

May 29, 2023
ALT 70
AST 38

July 1 2024
ALT 74
AST 40

My question is, I also had a baby in August 2020 and in November 2020 my ALT was also 53 and AST was 38 but then it came back down.

I brought this up to my doctor and she said post partum flares weren’t really a thing but when I look it up it seems to be fairly common? I’m worried because I’m 3 months post partum this time and it doesn’t seem to be coming down. Does anyone have any other information regarding post partum flares in women?

To be noted, I’m not on anti viral treatment - DNA activity below

Hi @Albasil808,
Sorry to hear about you having these issues. Since this has happened before, I will agree with what your doctor has said. They know you best and have helped you through this once before. Let’s hope things go back to normal as they did in the past soon. Best, Bansah1.

Hi @Albasil808,

My understanding is that post-partum flares are definitely a thing that happens and is well documented. Would love the input of any @HealthExperts on their experience and expertise in the matter.


Postpartum flares definitely happen. I can’t tell from what you are saying but did your viral load go up as well or just your liver enzymes? Do you have any other conditions that could cause elevated liver enzymes- I’m thinking fatty liver (now called steatotic liver disease) that can come from from prediabetes, diabetes, elevated lipids, elevated BMI, etc…
Flares are not all bad, there can be “good flares” that lead to your immune system clearing the virus and this happens to some people around pregnancy. It can lead to hepatitis B seroconversion (loss of HBsAg) which of course, is a great outcome.
Sometimes the liver enzyme elevation just a blip and will return to normal, but if it doesn’t and you can’t find any other cause, you may want to go on antiviral therapy.
Take care!
(As a mom of 4, I noticed elevations of my VL around the time of pregnancy/delivery as well. I had a slow trend up of my HBV DNA but I think that was just aging as well and the immune escape that happens with mutant strains. I eventually went on antiviral therapy after my last pregnancy. My VL hovered in the hundreds for the most part but went over 2,000 a few times around pregnancy and after, and that was enough for me. My liver enzymes were always normal, really low like in the single digits, I’m a petite person)


I would agree, postpartum HBV-related ALT flares in untreated women can occur but they generally mild without clinical consequences


I agree with others postpartum flares are common and usually not significant. However it is important to be monitored (i.e., checking your liver tests) as they can rarely be severe