Background: Intrahepatic cholestasis of pregnancy (ICP) is the commonest gestational liver disease. The risk of adverse fetal outcome has been associated with the severity of maternal hypercholanemia after diagnosis.
Objective: To investigate whether there is a relationship between the severity and timing of onset of hypercholanemia and the risk of meconium-stained amniotic fluid (MSAF) and adverse neonatal events.
Study Design: The study included 382 pregnancies complicated by ICP managed at a referral hospital in Buenos Aires (Argentina) between June 2009 and December 2013. The patients were classified into three groups according to the severity of hypercholanemia at diagnosis; mild (10-19.9 μmol/L), moderate (20-39.9 μmol/L) and severe (≥40 μmol/L). Their clinical characteristics and pregnancy outcomes were investigated in a prospective observational study.
Results: Higher risk of MSAF was observed when ICP appeared early in gestation or when hypercholanemia was more severe. Taking both parameters into account an MSAF risk factor (MRF) was defined. Based on a model of positive/negative predictive values, a cut-off point of MRF = 3 was selected, which prioritized sensitivity versus specificity. In ICP patients with MRF>3, the probability of MSAF was enhanced 4-fold. An increase in the frequency of MSAF was also associated with higher serum levels at diagnosis of alanine transaminase, alkaline phosphatase and direct bilirubin.
Conclusions: The risk of MSAF is associated not only with the magnitude of hypercholanemia at diagnosis but also with the early gestational onset of raised maternal serum bile acids.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5402936 | PMC |
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0176504 | PLOS |
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Department of Gastroenterology, Kunming Children's Hospital, Kunming, China.
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Division of Gastroenterohepatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
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Department of Gynecology and Obstetrics, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, People's Republic of China.
The ABCB4 gene encodes multidrug resistance protein 3(MDR3), which is a phosphatidylcholine(PC) transfer enzyme that transfers lecithin from the inner part of the phospholipid bilayer to the extracellular bile. The occurrence of intrahepatic cholestasis of pregnancy(ICP) is closely related to ABCB4 variants, but there is limited research on this topic in southern Anhui, China. We sequenced ABCB4 in pregnant women with ICP and healthy pregnant women to explore the relationship.
View Article and Find Full Text PDFBr J Hosp Med (Lond)
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Department of Obstetrics, Beilun District People's Hospital, Ningbo, Zhejiang, China.
Intrahepatic cholestasis of pregnancy (ICP) is associated with adverse perinatal outcomes, yet the correlation between ICP and the neutrophil-to-lymphocyte ratio (NLR) remains unclear. This study aims to investigate the diagnostic value of NLR in ICP. In this retrospective case-control study, 113 patients with ICP treated in Beilun District People's Hospital from January 2020 to December 2022 were recruited and categorized as the ICP group, and 209 healthy pregnant women treated during the same period were selected as the control group.
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