Garcia-Flores Jose, Cañamares Marina, Cruceyra Mireia, Garicano Ainhoa, Espada Mercedes, Lopez Ana, Tamarit Ines
Obstetrics and Gynecology Department, Hospital Universitario Quiron Madrid, Madrid, Spain.
Gynecol Obstet Invest. 2015;79(4):222-8. doi: 10.1159/000370003. Epub 2015 Feb 26.
To evaluate the correlation between perinatal outcome and bile acid levels in intrahepatic cholestasis of pregnancy (ICP), and to evaluate variations in the mean bile acid level when stratifying by maternal and perinatal factors. A comparison between mild and severe ICP was made.
A prospective observational study was performed in pregnant patients who underwent blood tests for bile acids due to persistent pruritus. Based on bile acid levels, maternal and neonatal data were obtained and were compared between patients presenting with ICP and gestational pruritus (normal bile acid level).
A total of 145 patients were included, 47 of whom were diagnosed as ICP (52 newborns) and 98 as gestational pruritus (102 newborns). The ICP group had a higher rate of NICU admission (14/42 vs. 6/98, p < 0.001) and global neonatal morbidity (13/42 vs. 9/98, p = 0.002), but these differences were no longer seen after adjusting for gestational age, singleton pregnancies and induction of labour. Patients presenting with severe ICP (maximum bile acids levels above 40 µmol/l) showed a higher rate of meconium-stained amniotic fluid (0/28 vs. 4/14, p = 0.009), NICU admission (9/34 vs. 11/17, p = 0.01) and neonatal global morbidity (5/32 vs. 8/17, p = 0.02).
ICP patients have higher rates of adverse neonatal outcomes when compared to those with gestational pruritus. Some of this neonatal morbidity may be secondary to late spontaneous preterm deliveries, multiple gestation and a policy of elective induction of labour after 37 weeks of gestation. A comparison of outcomes among patients with mild and severe ICP shows that the severely affected group has higher rates of meconium-stained amniotic fluid and neonatal morbidity.
评估妊娠肝内胆汁淤积症（ICP）患者围产期结局与胆汁酸水平之间的相关性，并评估根据母体和围产期因素分层时平均胆汁酸水平的变化。对轻度和重度ICP进行比较。
对因持续性瘙痒而接受胆汁酸血液检测的孕妇进行前瞻性观察研究。根据胆汁酸水平，获取母体和新生儿数据，并在患有ICP和妊娠瘙痒（胆汁酸水平正常）的患者之间进行比较。
共纳入145例患者，其中47例被诊断为ICP（52例新生儿），98例为妊娠瘙痒（102例新生儿）。ICP组入住新生儿重症监护病房（NICU）的比例（14/42对6/98，p<0.001）和新生儿总体发病率（13/42对9/98，p = 0.002）较高，但在调整孕周、单胎妊娠和引产因素后，这些差异不再明显。重度ICP患者（最大胆汁酸水平高于40µmol/l）的羊水粪染率（0/28对4/14，p = 0.009）、入住NICU的比例（9/34对11/17，p = 0.01）和新生儿总体发病率（5/32对8/17，p = 0.02）较高。
与妊娠瘙痒患者相比，ICP患者不良新生儿结局的发生率更高。部分新生儿发病率可能继发于晚期自然早产、多胎妊娠以及妊娠37周后选择性引产的政策。轻度和重度ICP患者结局的比较表明，严重受累组羊水粪染和新生儿发病率较高。
