The relationship of bile acid with biochemical tests in the diagnosis of intrahepatic cholestasis of pregnancy

Intrahepatic pregnancy cholestasis (ICP) is associated with increased fetal complications. It is linked to an increased risk. Early diagnosis of this disease reduces these fetal complications. In this study, it was aimed to determine the sensitivity and specificity of biochemical tests according to cut off values. The values of 14 patients with bile acid ≥40 μmol / L diagnosed with intrahepatic cholestasis of pregnancy and 40 patients with bile acid <40 μmol / L were compared retrospectively with 60 control patients. In ICP patients, the ALT and AST values in patients with group 1 with bile acid ≥40 μmol / L and group 2 with bile acid <40 μmol / L were significantly higher than the control group (p = 0.0001 for both markers). Groups 1 and 2 with ICP patients have high sensitivity and specificity compared to the cut off value of ALT and AST. In our study, it was found that increased the risk of preterm delivery in ICP patients. Especially in cases where bile acid was ≥ 40 μmol / L, complications such as preterm delivery and low birth weight increased in proportion to the increase in bile acid. In the ICP patients, AST and especially ALT values increased in proportion to the increase in bile acid.

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Association of ABCB4 and ABCB11 nucleotide variants with intrahepatic cholestasis of pregnancy

Journal of Medical Science ◽

10.20883/medical.388 ◽

2019 ◽

Vol 88 (4) ◽

pp. 209-217

Author(s):

Milena Gruszczyńska-Losy ◽

Adrianna Mostowska ◽

Łukasz Adamczak ◽

Paweł Jagodziński ◽

Ewa Wender-Ożegowska ◽

...

Keyword(s):

Pregnant Women ◽

Intrahepatic Cholestasis ◽

Clinical Symptoms ◽

Melting Curve ◽

Liver Disorder ◽

Melting Curve Analysis ◽

Control Group ◽

Intrahepatic Cholestasis Of Pregnancy ◽

Increased Risk ◽

Cholestasis Of Pregnancy

Background: Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disorder during gestation. The exact pathogenesis of ICP is multifactorial and still unclear. Therefore, our study aimed to check whether the selected ABCB4and ABCB11nucleotide variants are associated with an increased risk of ICP. Methods:ICP was diagnosed based on clinical symptoms characteristic of this disease and confirmed by increase in serum bile acids and transaminases, spontaneous resolution of clinical symptoms and normalization of laboratory tests after delivery. The total of 86 pregnant women meeting the criteria were included into the study. Healthy pregnant women with uncomplicated pregnancy served as control group (n=310). Sixcommon nucleotide variants in theABCB11and ABCB4genes were genotypedwith the use of high-resolution melting curve analysis. Conclusion:Our study did not show any significant association of analysed ABCB4and ABCB11nucleotide variants with the increased risk of intrahepatic cholestasis of pregnancy.

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Intrahepatic Cholestasis of Pregnancy: Natural History and Current Management

Seminars in Liver Disease ◽

10.1055/s-0040-1722264 ◽

2021 ◽

Author(s):

Rebecca Roediger ◽

Jaquelyn Fleckenstein

Keyword(s):

Adverse Effects ◽

Intrahepatic Cholestasis ◽

Elevated Serum ◽

Reproductive Hormones ◽

Intrahepatic Cholestasis Of Pregnancy ◽

Current Management ◽

Immune Mediated ◽

Increased Risk ◽

Fetal Complications ◽

Cholestasis Of Pregnancy

AbstractIntrahepatic cholestasis of pregnancy (ICP) is a common disorder in the second half of pregnancy characterized by pruritus and elevated serum bile acids (BAs) with spontaneous resolution after delivery. ICP carries a risk of adverse effects on the fetus which correlates with the degree of BA elevation. ICP occurs in genetically susceptible women as the reproductive hormones increase during pregnancy. Ursodeoxycholic acid is still considered the first-line treatment for ICP though it is of unproven benefit in preventing adverse effects on the fetus. Fetal complications, such as stillbirth, increase with gestational age, so preterm delivery is generally performed in cases of severe ICP, defined as BA levels above 40 μmol/L. ICP may recur in future pregnancies and is associated with an increased risk for future hepatobiliary, immune mediated, and cardiovascular diseases. Children born of mothers with ICP have normal development but may have a risk for subsequent metabolic disease.

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Acidosis: A potential explanation for adverse fetal outcome in intrahepatic cholestasis of pregnancy. A case report

Obstetric Medicine ◽

10.1177/1753495x14553649 ◽

2014 ◽

Vol 7 (4) ◽

pp. 177-179 ◽

Cited By ~ 1

Author(s):

K Sterrenburg ◽

W Visser ◽

LS Smit ◽

J Cornette

Keyword(s):

Bile Acid ◽

Intrahepatic Cholestasis ◽

Fetal Outcome ◽

Maternal Serum ◽

Gas Analysis ◽

Serum Bile Acid ◽

Intrahepatic Cholestasis Of Pregnancy ◽

Bile Acid Concentration ◽

Increased Risk ◽

Cholestasis Of Pregnancy

Background Intrahepatic cholestasis of pregnancy is a cholestatic disorder with an increased risk for adverse perinatal outcome. The mechanism underlying intrauterine demise is poorly understood. Case A nulliparous woman with gestational age of 36 plus 6 weeks presented with suspected intrahepatic cholestasis. Continuous CTG monitoring evolved from a normal pattern towards a non-reassuring pattern. A male neonate was delivered by caesarean section. Apgar scores 0, 1 and 4 at 1, 5 and 10 min. Fetal cord gas analysis showed pH 6.98, base deficit –15 mmol/L. Blood results showed maternal serum bile acid concentration of 220 µmol/L. Conclusion Our case suggests gradual evolution towards hypoxia and acidosis. It is unknown whether certain components in the bile acid concentrations might contribute to a fetal metabolic component of the acidosis.

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Intrahepatic cholestasis of pregnancy: Relationship between bile acid levels and maternal and fetal complications

Journal of Turkish Society of Obstetric and Gynecology ◽

10.4274/tjod.28000 ◽

2014 ◽

Vol 11 (3) ◽

pp. 148-152

Author(s):

Bilge Çetinkaya Demir ◽

Esra Şahin Güneş ◽

Mehmet Aral Atalay

Keyword(s):

Bile Acid ◽

Intrahepatic Cholestasis ◽

Intrahepatic Cholestasis Of Pregnancy ◽

Fetal Complications ◽

Cholestasis Of Pregnancy

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Sensitivity and Specificity of Biochemical Tests for Diagnosis of Intrahepatic Cholestasis of Pregnancy

Annals of Hepatology ◽

10.5604/01.3001.0010.0294 ◽

2017 ◽

Vol 16 (4) ◽

pp. 569-573 ◽

Cited By ~ 5

Author(s):

Kondrackiene Jurate ◽

Zalinkevicius Rimantas ◽

Sumskiene Jolanta ◽

Gintautas Vladas ◽

Kupcinskas Limas

Keyword(s):

Sensitivity And Specificity ◽

Intrahepatic Cholestasis ◽

Intrahepatic Cholestasis Of Pregnancy ◽

Biochemical Tests ◽

Cholestasis Of Pregnancy

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Assessment of Mechanical Fetal PR Interval in Intrahepatic Cholestasis of Pregnancy and Its Relationship with the Severity of the Disease

American Journal of Perinatology ◽

10.1055/s-0039-1694726 ◽

2019 ◽

Vol 37 (14) ◽

pp. 1476-1481

Author(s):

Kadriye Yakut ◽

Fatma Doğa Öcal ◽

Merve Öztürk ◽

Filiz Halici Öztürk ◽

Yüksel Oğuz ◽

...

Keyword(s):

Pregnant Women ◽

Intrahepatic Cholestasis ◽

Control Group ◽

Intrahepatic Cholestasis Of Pregnancy ◽

Positive Correlation ◽

Severity Of Disease ◽

Pr Interval ◽

Fetal Complications ◽

Severity Of The Disease ◽

Cholestasis Of Pregnancy

Abstract Objective This study aimed to investigate the fetal atrioventricular conduction system in intrahepatic cholestasis of pregnancy (ICP) by measuring the fetal mechanical PR interval and to explore the significance of predicting the severity of the disease. Study Design Forty pregnant women diagnosed with ICP, classified as severe and mild, and 40 healthy pregnant women participated in the study. Fetal mechanical PR interval was calculated, and fetal mechanical PR interval and neonatal outcome were compared between the groups. The relationship between the mechanical PR interval and the severity of ICP was analyzed. Results The fetal mechanical PR interval was significantly longer in the ICP group than in the control group (p < 0.005). Likewise, laboratory parameters such as transaminases (alanine aminotransferase [ALT], aspartate aminotransferase [AST]) and total bilirubin levels were significantly higher in the ICP group (p < 0.005).There were no statistically significant differences in the fetal complications. There was a positive correlation between the severity of disease and fetal PR interval. Conclusion A prolonged fetal mechanical PR interval in fetuses of mothers with ICP was demonstrated in this study. It was also shown that there was a positive correlation between fetal PR interval and severity of the disease. The study concluded that fetal mechanical PR interval measurement can be used to predict the severity of disease in ICP.

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Alterations of the Human Gut Microbiota in Intrahepatic Cholestasis of Pregnancy

Frontiers in Cellular and Infection Microbiology ◽

10.3389/fcimb.2021.635680 ◽

2021 ◽

Vol 11 ◽

Author(s):

Qitao Zhan ◽

Xuchen Qi ◽

Ruopeng Weng ◽

Fangfang Xi ◽

Yuan Chen ◽

...

Keyword(s):

Gut Microbiota ◽

Real Time ◽

Ribosomal Rna ◽

Intrahepatic Cholestasis ◽

Unsaturated Fatty Acids ◽

Control Group ◽

Intrahepatic Cholestasis Of Pregnancy ◽

Fetal Complications ◽

Polymerase Chain ◽

Cholestasis Of Pregnancy

Background and AimsWomen with severe intrahepatic cholestasis of pregnancy (ICP) are at higher risks of fetal complications and without effective treatments. Changes in gut microbiota in pregnancy were found to be related to the altered intestinal bile acid composition, so we aimed to explore the alterations of microbiota in the gut of ICP patients.MethodsA total of 90 women were recruited, including 45 ICP patients and 45 healthy controls. The gut microbiota communities of ICP group were compared to control group through 16S ribosomal RNA gene sequencing. The results were then confirmed by real-time polymerase chain reaction (PCR) and generalized linear model (GLM). Furthermore, we analyzed the relationships between microbiota and the severity of ICP.ResultsA total of seven genera and nine taxa with differential abundances between the ICP patients and the controls were identified. All of the seven genera were verified through real-time PCR, and three key genera Parabacteroides, Flavonifractor, and Megamonas were confirmed by using the GLM model. Further analysis found that the genera Escherichia_Shigella, Olsenella, and Turicibacter were enriched in the severe ICP group, the microbial gene function related to biosynthesis of unsaturated fatty acids and propanoate metabolism were also increased in them.ConclusionsOverall, our study was the first in Asia to demonstrate an association between gut microbiota and ICP. Our findings would contribute to a better understanding of the occurrence of ICP.

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