Sarker Minhazur R, Ramos Gladys A, Ferrara Lauren, Debolt Chelsea A
Department of Obstetrics, Gynecology and Reproductive Science, University of California, San Diego, San Diego, California; and the Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System & Icahn School of Medicine at Mount Sinai, New York, and the Department of Obstetrics, Gynecology and Reproductive Science, New York City Health and Hospitals - Elmhurst Hospital Center, Elmhurst, New York.
Obstet Gynecol. 2025 Mar 1;145(3):343-345. doi: 10.1097/AOG.0000000000005846. Epub 2025 Jan 30.
Although peak serum total bile acid (TBA) levels guide management of intrahepatic cholestasis of pregnancy (ICP), whether ICP progresses in severity and when or how to assess bile acid levels serially remains unclear. We conducted a secondary analysis of a single-institution retrospective cohort study to assess bile acid trends across pregnancy among individuals diagnosed with ICP and to evaluate whether there was progression to higher ICP severity. We defined ICP severity as mild (peak TBA less than 40 micromol/L), moderate (peak TBA between 40 and 100 micromol/L), or severe (peak TBA 100 micromol/L or greater). Among the 1,188 patients with ICP in our cohort, 354 (29.8%) had repeat bile acid level measurements. Of those patients, 88 (24.9%) progressed to higher ICP severity that may have resulted in changes to delivery timing. Further studies are needed to determine whether serial assessment of bile acid levels with potential reclassification of ICP severity improves outcomes.
尽管血清总胆汁酸（TBA）峰值水平指导着妊娠期肝内胆汁淤积症（ICP）的管理，但ICP的严重程度是否会进展以及何时或如何连续评估胆汁酸水平仍不明确。我们对一项单机构回顾性队列研究进行了二次分析，以评估诊断为ICP的个体在整个孕期的胆汁酸变化趋势，并评估是否会进展为更严重的ICP。我们将ICP严重程度定义为轻度（TBA峰值小于40微摩尔/升）、中度（TBA峰值在40至100微摩尔/升之间）或重度（TBA峰值为100微摩尔/升或更高）。在我们队列中的1188例ICP患者中，354例（29.8%）进行了重复胆汁酸水平测量。在这些患者中，88例（24.9%）进展为更严重的ICP，这可能导致了分娩时间的改变。需要进一步的研究来确定对胆汁酸水平进行连续评估以及对ICP严重程度进行潜在重新分类是否能改善结局。
