Intrahepatic cholestasis of pregnancy: are in vitro fertilization pregnancies at risk?

BMC Pregnancy Childbirth

Gong

et al. 2022

Background Intrahepatic cholestasis of pregnancy is one of the common complications during pregnancy, and ursodeoxycholic acid has been recommended as the first-line drug. However, if the assisted reproductive technology may increase adverse perinatal outcomes of twin pregnancies complicated by intrahepatic cholestasis is disputed, we aimed to investigate perinatal outcomes between twin pregnancies by assisted reproductive technology versus spontaneous conception, based on these women accepted ursodeoxycholic acid treatment. Methods From January 2014 to January 2019, we retrospectively analysed the clinical data of twin pregnant women with intrahepatic cholestasis, excluding those who did not receive ursodeoxycholic acid treatment. In total, 864 women were included, among whom 500 conceived by assisted reproductive technology and 364 conceived by spontaneous conception. The primary assessment for perinatal outcomes included premature birth, meconium-stained amniotic fluid, low Apgar score, neonatal intensive care unit and still birth, and secondary indicators were serum bile acid and liver enzymes level during medication, so we also finished subgroup analysis based on different elevated bile acid level and drug usage. The statistical analysis was performed by SPSS 22.0. Results The study demonstrated that compared to spontaneous conception, assisted reproductive technology conceived twin pregnancies diagnosed as intrahepatic cholestasis earlier (p = 0.003), and lower birth weight (p = 0.001), less incidence of preterm delivery (p = 0.000) and neonatal intensive care unit admission (p = 0.001), but the rate of meconium-stained amniotic fluid, low Apgar score and still birth have no statistic differences. Moreover, the subgroup analysis showed no significant difference in elevated bile acid levels and medication between assisted reproductive technology and spontaneous conception groups. Conclusions The assisted reproductive technology may increase the risk of early-onset intrahepatic cholestasis in twin pregnancies, but it does not seem to increase adverse effects on bile acid levels and perinatal outcomes. Regardless of ursodeoxycholic acid used alone or combination, the effect of bile acid reduction and improving perinatal outcomes in twin pregnancies is limited. Our conclusions still need more prospective randomized controlled studies to confirm.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The impact of assisted reproductive technology in twin pregnancies complicated by intrahepatic cholestasis: a five-year retrospective study

BMC Pregnancy Childbirth

Gong

et al. 2022

“…ICP is one of the main complications during pregnancy, and the incidence during twin pregnancies is higher than that during singleton pregnancy because of widely used ART, but there is no conclusion regarding whether ART may signi cantly increase adverse perinatal outcomes in ICP (6,19), (22) . Moreover, UDCA has always been recommended for reducing bile acid, but controversy remains if it could improve perinatal outcomes in twin pregnancies with ICP (2) .…”

Section: Discussionmentioning

confidence: 99%

“…The varied incidence of ICP is 0.3%-5.6% among pregnant women, but it could be 20.9%~24.6% during twin pregnancies because ART has been widely applied in infertile women (17),( 18), (19) . Compared to spontaneous pregnancy, it has not been con rmed that if ART conceived twins may develop a higher incidence of adverse perinatal outcomes (20), (21), (22) . The present study was based on evaluating UDCA treatment by subgroup analysis and aimed to determine whether ART is associated with adverse outcomes during twin pregnancies with ICP.…”

Section: Introductionmentioning

confidence: 99%

Perinatal Outcomes Of Ursodeoxycholic Acid Treatment In Twin Pregnancies With Intrahepatic Cholestasis: A Five-Year Retrospective Cohort Study

Gong

et al. 2022

Preprint

Background: Intrahepatic cholestasis of pregnancy is one of the common complications during pregnancy, and ursodeoxycholic acid has been recommended as the first-line drug. However, if ursodeoxycholic acid could improve the perinatal outcomes of multiple pregnancies is unclear, we aimed to investigate perinatal outcomes in twin pregnancies with intrahepatic cholestasis by assisted reproductive technology or spontaneous conception. Methods: From January 2014 to January 2019, we retrospectively analysed the clinical data of twin pregnant women with intrahepatic cholestasis, excluding those who did not receive ursodeoxycholic acid treatment. In total, 864 women were included, among whom 500 conceived by assisted reproductive technology and 364 conceived by spontaneous conception. The primary assessment for perinatal outcomes included premature birth, meconium-stained amniotic fluid, low Apgar score, neonatal intensive care unit and still birth, and secondary indicators were serum bile acid and liver enzymes level during medication, so we also finished subgroup analysis based on different elevated bile acid level and drug usage. The statistical analysis was performed by SPSS 22.0.Results: The study demonstrated that compared to spontaneous conception, assisted reproductive technology conceived twin pregnancies diagnosed as intrahepatic cholestasis earlier (p=0.003), and lower birth weight(p=0.001), less incidence of preterm delivery(p=0.000) and neonatal intensive care unit admission (p=0.001), but the rate of meconium-stained amniotic fluid, low Apgar score and still birth have no statistic differences. Moreover, the subgroup analysis showed no significant difference in elevated bile acid levels and medication between assisted reproductive technology and spontaneous conception groups.Conclusions: Assisted reproductive technology may increase the risk of early-onset intrahepatic cholestasis in twin pregnancies, but it does not seem to increase adverse effects on bile acid levels and perinatal outcomes. Regardless of the use of ursodeoxycholic acid alone or combination, ursodeoxycholic acid for bile acid reduction and improving perinatal outcomes in twin pregnancies is limited. Our conclusions still need more prospective randomized controlled studies to confirm.

“…Intrahepatic cholestasis during pregnancy is a common clinical hepatobiliary disease that leads to adverse fetal outcomes and may lead to unexpected and sudden fetal death. Therefore, once the disease is diagnosed, intervention measures should be taken immediately [ 13 ]. Currently, for pregnant women with a gestation cycle of about 29 weeks, the measured TBA is used as an indicator of liver function, and intrahepatic cholestasis during pregnancy is screened according to whether the clinical symptoms contain pruritus [ 14 – 16 ].…”

Section: Discussionmentioning

confidence: 99%

Deep Learning Algorithm-Based Magnetic Resonance Imaging Feature-Guided Serum Bile Acid Profile and Perinatal Outcomes in Intrahepatic Cholestasis of Pregnancy

Liu

Wang

Computational and Mathematical Methods in Medicine

2022

This study was aimed to explore magnetic resonance imaging (MRI) based on deep learning belief network model in evaluating serum bile acid profile and adverse perinatal outcomes of intrahepatic cholestasis of pregnancy (ICP) patients. Fifty ICP pregnant women diagnosed in hospital were selected as the experimental group, 50 healthy pregnant women as the blank group, and 50 patients with cholelithiasis as the gallstone group. Deep learning belief network (DLBN) was built by stacking multiple restricted Boltzmann machines, which was compared with the recognition rate of convolutional neural network (CNN) and support vector machine (SVM), to determine the error rate of different recognition methods on the test set. It was found that the error rate of deep learning belief network (7.68%) was substantially lower than that of CNN (21.34%) and SVM (22.41%) ( P < 0.05 ). The levels of glycoursodeoxycholic acid (GUDCA), glycochenodeoxycholic acid (GCDCA), and glycocholic acid (GCA) in the experimental group were dramatically superior to those in the blank group ( P < 0.05 ). Both the experimental group and the blank group had notable clustering of serum bile acid profile, and the experimental group and the gallstone group could be better distinguished. In addition, the incidence of amniotic fluid contamination, asphyxia, and premature perinatal infants in the experimental group was dramatically superior to that in the blank group ( P < 0.05 ). The deep learning confidence model had a low error rate, which can effectively extract the features of liver MRI images. In summary, the serum characteristic bile acid profiles of ICP were glycoursodeoxycholic acid, glycochenodeoxycholic acid, and glycocholic acid, which had a positive effect on clinical diagnosis. The toxic effects of high concentrations of serum bile acids were the main cause of adverse perinatal outcomes and sudden death.