Huri Mor, Seravalli Viola, Lippi Camilla, Tofani Lorenzo, Galli Andrea, Petraglia Felice, Di Tommaso Mariarosaria
Obstetrics and Gynaecology Unit, Department of Health Sciences, University of Florence, Florence, Italy.
Department of Statistics, Computer Science, Applications, University of Florence, Florence, Italy.
BJOG. 2022 Oct;129(11):1887-1896. doi: 10.1111/1471-0528.17174. Epub 2022 Apr 22.
To establish pregnancy-specific reference ranges for fasting and postprandial total serum bile acid (TSBA) concentrations.
Cross-sectional study.
Tertiary-care university hospital.
Healthy pregnant women at term admitted to the Obstetrics Department over a period of 1 year. Exclusion criteria were an established diagnosis of intrahepatic cholestasis of pregnancy (ICP) or any coexisting condition of increased risk for ICP.
Both fasting (after 8-14 h of fasting) and postprandial (2 h after meal) TSBA concentrations were measured in 612 women (with 528 fasting samples and 377 postprandial samples) by automated enzymatic spectrophotometric assay.
Fasting and postprandial TSBA concentrations in 612 women.
Reference intervals of 4.4-14.1 μmol/L for fasting TSBA and 4.7-20.2 μmol/L for postprandial TSBA were established. The postprandial values were significantly higher than the fasting values, with a median increase of 1.0 μmol/L (p < 0.0001). A correlation between fasting TSBA concentrations and postprandial concentrations was found, as well as correlations with fetal sex, parity and assisted reproductive technologies. A seasonal pattern was noticed for both fasting and postprandial TSBA, with the highest values measured in the winter season (p < 0.01 and 0.02, respectively) CONCLUSIONS: Normal pregnancy is associated with mild hypercholanaemia, and therefore a higher threshold should be considered for the diagnosis of ICP. We suggest using the upper reference limits observed in our healthy pregnant population (14 μmol/L for fasting TSBA and 20 μmol/L for postprandial TSBA). As the fasting measurement is more specific for the diagnosis, and the postprandial measurement is essential for the assessment of severity, it is recommended to measure both values rather than use random sampling.
Normal pregnancy is associated with mild hypercholanaemia, a higher threshold should be considered for the diagnosis of ICP.
建立空腹和餐后血清总胆汁酸（TSBA）浓度的孕期特异性参考范围。
横断面研究。
三级医疗大学医院。
在1年期间入住产科的足月健康孕妇。排除标准为已确诊的妊娠期肝内胆汁淤积症（ICP）或任何并存的增加ICP风险的情况。
通过自动酶促分光光度法测量了612名女性（528份空腹样本和377份餐后样本）的空腹（禁食8 - 14小时后）和餐后（餐后2小时）TSBA浓度。
612名女性的空腹和餐后TSBA浓度。
建立了空腹TSBA的参考区间为4.4 - 14.1μmol/L，餐后TSBA的参考区间为4.7 - 20.2μmol/L。餐后值显著高于空腹值，中位数增加1.0μmol/L（p < 0.0001）。发现空腹TSBA浓度与餐后浓度之间存在相关性，以及与胎儿性别、产次和辅助生殖技术之间的相关性。空腹和餐后TSBA均呈现季节性模式，冬季测量值最高（分别为p < 0.01和0.02）。结论：正常妊娠与轻度高胆酸血症相关，因此在诊断ICP时应考虑更高的阈值。我们建议使用在我们健康孕妇群体中观察到的参考上限（空腹TSBA为14μmol/L，餐后TSBA为20μmol/L）。由于空腹测量对诊断更具特异性，而餐后测量对评估严重程度至关重要，建议同时测量这两个值而不是采用随机抽样。
正常妊娠与轻度高胆酸血症相关，诊断ICP时应考虑更高的阈值。
