Early Detection of Intrahepatic Cholestasis of Pregnancy: Correlation Between Liver Enzymes and Adverse Fetal Outcomes

Abstract

Background: Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder that occurs in late pregnancy and leads to elevated bile acid levels in the maternal serum, posing risks to fetal health, including preterm labor and fetal distress. Understanding the relationships between liver enzyme levels and fetal outcomes can guide early diagnostic and management strategies. Objective: To evaluate the significance of early detection of ICP through routine liver enzyme tests (AST and ALT) and its correlation with adverse fetal outcomes to inform clinical practices in regions with limited access to advanced diagnostic tools. Methods: This cross-sectional study was conducted at the Ittefaq Hospital Trust, Lahore, involving 90 pregnant women categorized into three groups based on gestational age and ICP symptoms. Group A consisted of 30 women at 30-34 weeks of gestation, Group B included 30 women at 34-37 weeks, and Group C comprised 30 healthy pregnant women as controls. Serum AST and ALT levels were measured at day 0, 30, and 45. Fetal outcomes were monitored through ultrasound and medical records. Statistical analysis was performed using SPSS version 25, employing descriptive statistics and ANOVA to compare enzyme levels and fetal outcomes across groups. Results: Group 2 exhibited significantly higher mean AST levels (96.58 U/L) and ALT levels (183.10 U/L) compared to Group 1 (AST: 49.95 U/L, ALT: 100.90 U/L) and Group 3 (AST: 25.30 U/L, ALT: 35.05 U/L). Adverse fetal outcomes, including intrauterine growth restriction (IUGR), were notably higher in Group 2 (76.7%) compared to Group 1 (13.33%) and Group 3 (0%). The statistical significance was marked with a p-value < 0.05 across all comparisons. Conclusion: Elevated liver enzymes, specifically AST and ALT, are strongly associated with adverse fetal outcomes in ICP. Early detection and monitoring of these enzymes can be crucial in preventing fetal complications, particularly in resource-limited settings where traditional diagnostic measures are inaccessible.