Gynaecological and Obstetrical University Hospital in Poznan, Poland.
Department of Reproduction, Chair of Obstetrics, Gynaecology, and Gynaecological Oncology, Poznan University of Medical Sciences, Poland.
Ginekol Pol. 2020;91(5):269-276. doi: 10.5603/GP.2020.0051.
Intrahepatic cholestasis of pregnancy (ICP) is significantly more often associated with an abnormal perinatal outcome compared to a group of healthy pregnant women. The aim of the study was to analyse the correlation between the adverse perinatal outcome and the biochemical parameters in pregnancy complicated by cholestasis, and to assess their predictive value for neonatal complications.
Eighty-six patients with ICP were divided into 3 groups according to their fasting serum bile acid level [group I n = 60, 10-39.90 μmol/L; group II n = 20, 40-99.90 μmol /L; group III n = 6, TBA (total bile acids) ≥ 100.00 μmol/L]. Linear regression models were created to determine the relation of serum TBA, ALT, and AST concentration with total adverse perinatal outcome, defined as an occurrence of at least one perinatal outcome: stillbirth, preterm birth, spontaneous and iatrogenic preterm birth, presence of meconium in amniotic fluid, Apgar score (< 7 in 5th min), pH from umbilical artery (< 7.1), necessity for NICU admission, the presence of breathing disorders, and the need to perform phototherapy.
TBA ≥ 40.00 μmol/L is connected to an elevated risk of the occurrence of total adverse perinatal outcome (OR = 4.17, p = 0.0037, AUC = 0.62, p = 0.046). TBA ≥ 40.00 μmol/L is a predictor of preterm birth (OR 2.3, p = 0.0117), iatrogenic preterm birth (OR 2.5, p = 0.006), admission to NICU (OR 2.38, p = 0.0094), intubation or assisted ventilation (OR 2.16, p = 0.0301), and phototherapy (OR 2.0, p = 0.0438). The threshold value of TBA for the need for phototherapy was 52.7 μmol/L (AUC = 0.67, p = 0.0089) and for preterm birth, 32.1 μmol/L (AUC = 0.62, p = 0.0251).
Pregnant women with ICP and TBA serum level over 40.00 μmol/L have a worse prognosis regarding obstetric outcomes. The concentration of bile acids is a predictor of the occurrence of adverse perinatal outcomes, although the concentration of ALT and AST failed to show such a connection.
与健康孕妇相比，妊娠肝内胆汁淤积症（ICP）显著更常与不良围产结局相关。本研究的目的是分析胆汁淤积性妊娠中不良围产结局与生化参数之间的相关性，并评估其对新生儿并发症的预测价值。
86 例 ICP 患者根据空腹血清胆汁酸水平分为 3 组[组 I n = 60，10-39.90 μmol/L；组 II n = 20，40-99.90 μmol/L；组 III n = 6，TBA（总胆汁酸）≥100.00 μmol/L]。建立线性回归模型以确定血清 TBA、ALT 和 AST 浓度与总不良围产结局的关系，总不良围产结局定义为至少发生一种围产结局：死胎、早产、自发性和医源性早产、羊水胎粪污染、Apgar 评分（第 5 分钟 < 7）、脐动脉 pH 值（<7.1）、需要入住 NICU、存在呼吸障碍和需要进行光疗。
TBA≥40.00 μmol/L 与总不良围产结局的发生风险升高相关（OR = 4.17，p = 0.0037，AUC = 0.62，p = 0.046）。TBA≥40.00 μmol/L 是早产（OR 2.3，p = 0.0117）、医源性早产（OR 2.5，p = 0.006）、入住 NICU（OR 2.38，p = 0.0094）、插管或辅助通气（OR 2.16，p = 0.0301）和光疗（OR 2.0，p = 0.0438）的预测因素。需要光疗的 TBA 阈值为 52.7 μmol/L（AUC = 0.67，p = 0.0089），早产的 TBA 阈值为 32.1 μmol/L（AUC = 0.62，p = 0.0251）。
血清 TBA 水平超过 40.00 μmol/L 的 ICP 孕妇的产科结局更差。胆汁酸浓度是不良围产结局发生的预测因素，尽管 ALT 和 AST 浓度未能显示出这种关联。
