Predictors of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy
Abstract
Objectives: Our objective was to evaluate in our clinic the perinatal outcomes of patients diagnosed with ICP based on pre-treatment maternal serum bile acid levels, attempt to identify the risk group and review the literature in light of this information.
Material and methods: In total, 370 patients diagnosed with ICP were included in the study, divided into two groups based on the fasting total serum bile acid level before UDCA (Group 1: 10 ≥ 40 μmol/L, and Group 2: ≥ 40 μmol/L). The groups were examined for clinical characteristics and pregnancy outcomes.
Results: It was found that preterm delivery and neonatal intensive care need increased at a serum bile acid cut-off value of 34 μmol/L. Regardless of serum bile acid, significantly higher rates of meconium-stained amniotic fluid and foetal distress were observed in patients whose diagnoses were made before 34 weeks of gestation.
Conclusions: Foetal complications over 40 μmol/L of serum bile acid were significantly increased. However, slightly lower levels cut-off values (34 μmol/L) were obtained in terms of preterm birth and neonatal intensive care need. The incidence of meconium-stained amniotic fluid and foetal distress was higher in patients whose diagnosis were made before 34 weeks of gestation.
Keywords: intrahepatic cholestasispregnancyperinatal complications
References
- Williamson C, Geenes V. Intrahepatic cholestasis of pregnancy. Obstet Gynecol. 2014; 124(1): 120–133.
- Herrera CA, Manuck TA, Stoddard GJ, et al. Perinatal outcomes associated with intrahepatic cholestasis of pregnancy. J Matern Fetal Neonatal Med. 2018; 31(14): 1913–1920.
- Perez MJ, Macias RIR, Marin JJG. Maternal cholestasis induces placental oxidative stress and apoptosis. Protective effect of ursodeoxycholic acid. Placenta. 2006; 27(1): 34–41.
- Geenes VL, Lim YH, Bowman N, et al. A placental phenotype for intrahepatic cholestasis of pregnancy. Placenta. 2011; 32(12): 1026–1032.
- Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: Relationships between bile acid levels and fetal complication rates. Hepatology. 2004; 40(2): 467–474.
- Geenes V, Chappell LC, Seed PT, et al. Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: a prospective population-based case-control study. Hepatology. 2014; 59(4): 1482–1491.
- Geenes V, Williamson C. Intrahepatic cholestasis of pregnancy. World Journal of Gastroenterology. 2009; 15(17): 2049.
- Estiú MC, Frailuna MA, Otero C, et al. Relationship between early onset severe intrahepatic cholestasis of pregnancy and higher risk of meconium-stained fluid. PLoS One. 2017; 12(4): e0176504.
- Wikström Shemer E, Marschall HU, Ludvigsson JF, et al. Intrahepatic cholestasis of pregnancy and associated adverse pregnancy and fetal outcomes: a 12-year population-based cohort study. BJOG. 2013; 120(6): 717–723.
- Martineau M, Raker C, Powrie R, et al. Intrahepatic cholestasis of pregnancy is associated with an increased risk of gestational diabetes. Eur J Obstet Gynecol Reprod Biol. 2014; 176: 80–85.
- Madazli R, Yuksel MA, Oncul M, et al. Pregnancy outcomes and prognostic factors in patients with intrahepatic cholestasis of pregnancy. J Obstet Gynaecol. 2015; 35(4): 358–361.
- Cui D, Zhong Y, Zhang L, et al. Bile acid levels and risk of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy: A meta-analysis. J Obstet Gynaecol Res. 2017; 43(9): 1411–1420.
- Kawakita T, Parikh LI, Ramsey PS, et al. Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy. Am J Obstet Gynecol. 2015; 213(4): 570.e1–570.e8.
- Oztas E, Erkenekli K, Ozler S, et al. Can routine laboratory parameters predict adverse pregnancy outcomes in intrahepatic cholestasis of pregnancy? J Perinat Med. 2015; 43(6): 667–674.
- Rook M, Vargas J, Caughey A, et al. Fetal outcomes in pregnancies complicated by intrahepatic cholestasis of pregnancy in a Northern California cohort. PLoS One. 2012; 7(3): e28343.
- Campos GA, Castillo RJ, Toro FG. [Effect of bile acids on the myometral contractility of the isolated pregnant uterus]. Rev Chil Obstet Ginecol. 1988; 53(4): 229–233.
- Germain AM, Kato S, Carvajal JA, et al. Bile acids increase response and expression of human myometrial oxytocin receptor. Am J Obstet Gynecol. 2003; 189(2): 577–582.
- WILLIAMSON C, GORELIK J, EATON B, et al. The bile acid taurocholate impairs rat cardiomyocyte function: a proposed mechanism for intra-uterine fetal death in obstetric cholestasis. Clinical Science. 2001; 100(4): 363–369.
- Williamson C, Gorelik J, Eaton BM, et al. The bile acid taurocholate impairs rat cardiomyocyte function: a proposed mechanism for intra-uterine fetal death in obstetric cholestasis. Clin Sci (Lond). 2001; 100(4): 363–369.
- Miragoli M, Kadir SH, Sheppard MN, et al. A protective antiarrhythmic role of ursodeoxycholic acid in an in vitro rat model of the cholestatic fetal heart. Hepatology. 2011; 54(4): 1282–1292.
