Sarker Minhazur R, Canfield Dana, Ferrara Lauren, Ramos Gladys A, DeBolt Chelsea A
Department of Obstetrics, Gynecology and Reproductive Science, University of California San Diego, San Diego, California.
Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, New York.
Am J Perinatol. 2025 Jul;42(10):1235-1242. doi: 10.1055/a-2483-5910. Epub 2024 Nov 26.
This study aimed to assess the association between increasing bile acid levels in pregnancies with cholestasis and adverse outcomes.This is a retrospective cohort study of singleton, non-anomalous gestations complicated by cholestasis delivered at a single academic medical center from 2005 to 2019. We compared rates of adverse outcomes in pregnancies complicated by mild cholestasis (initial total bile acid [TBA] <40 μmol/L and peak TBA <40 μmol/L), progressive cholestasis (initial TBA <40 μmol/L and peak TBA ≥40 μmol/L), and severe cholestasis (initial TBA ≥40 μmol/L). Our primary outcome was a composite adverse outcome including spontaneous preterm labor and delivery, umbilical artery pH <7.20, 5-minute Apgar <7, cesarean delivery for nonreassuring fetal heart rate tracing, meconium-stained amniotic fluid, and neonatal intensive care unit (NICU) admission. Analyses were performed using mild cholestasis as the base comparator and a second analysis using severe cholestasis as the base comparator.Of the 1,182 pregnancies complicated by cholestasis, 732 (61.9%) had mild cholestasis, 78 (6.6%) had progressive cholestasis, and 372 (31.5%) had severe cholestasis. After adjusting for confounders including gestational age at diagnosis and using mild cholestasis as the base comparator, both progressive and severe cholestasis were associated with the composite adverse outcome (progressive intrahepatic cholestasis of pregnancy [ICP], OR = 1.70; 95% CI: 1.04-2.78 and severe ICP, OR = 1.60; 95% CI: 1.24-2.06). When using progressive cholestasis as the base comparator, there were no statistically significant differences in the primary or secondary outcomes between progressive cholestasis and severe cholestasis.This study highlights the significance of monitoring peak bile acid levels and that some cases of cholestasis may progress in pregnancy and the adverse associations are better reflected by the peak TBA level and not the cholestasis severity at initial diagnosis. · Outcomes with worsening cholestasis severity (progressive) are unknown.. · Retrospective study comparing mild to progressive to severe cholestasis.. · Progressive cholestasis outcomes are more similar to severe cholestasis.. · Clinical utility of trending bile acids warrants further study..
本研究旨在评估妊娠期胆汁淤积症患者胆汁酸水平升高与不良结局之间的关联。这是一项回顾性队列研究，研究对象为2005年至2019年在一家学术医疗中心分娩的单胎、非畸形且合并胆汁淤积症的妊娠患者。我们比较了轻度胆汁淤积症（初始总胆汁酸[TBA]<40μmol/L且峰值TBA<40μmol/L）、进行性胆汁淤积症（初始TBA<40μmol/L且峰值TBA≥40μmol/L）和重度胆汁淤积症（初始TBA≥40μmol/L）的妊娠患者的不良结局发生率。我们的主要结局是一个综合不良结局，包括自发性早产和分娩、脐动脉pH<7.20、5分钟阿氏评分<7、因胎儿心率监护异常而行剖宫产、羊水粪染以及新生儿重症监护病房（NICU）收治。分析以轻度胆汁淤积症作为基础对照进行，第二次分析以重度胆汁淤积症作为基础对照。在1182例合并胆汁淤积症的妊娠患者中，732例（61.9%）为轻度胆汁淤积症，78例（6.6%）为进行性胆汁淤积症，372例（31.5%）为重度胆汁淤积症。在调整了包括诊断时孕周等混杂因素并以轻度胆汁淤积症作为基础对照后，进行性和重度胆汁淤积症均与综合不良结局相关（进行性妊娠肝内胆汁淤积症[ICP]，OR=1.70；95%CI：1.04-2.78；重度ICP，OR=1.60；95%CI：1.24-2.06）。当以进行性胆汁淤积症作为基础对照时，进行性胆汁淤积症和重度胆汁淤积症在主要或次要结局方面无统计学显著差异。本研究强调了监测胆汁酸峰值水平的重要性，且部分胆汁淤积症病例在妊娠期可能进展，不良关联通过TBA峰值水平而非初始诊断时的胆汁淤积症严重程度能得到更好反映。·胆汁淤积症严重程度加重（进行性）的结局尚不清楚。·回顾性研究比较轻度、进行性和重度胆汁淤积症。·进行性胆汁淤积症的结局与重度胆汁淤积症更相似。·监测胆汁酸的临床效用值得进一步研究。
