Intrahepatic cholestasis of pregnancy: Relationship between bile acid levels and maternal and fetal complications

Abstract

Objective:Intrahepatic cholestasis of pregnancy (ICP) complicates pregnancies which is characterized by elevated serum bile acid levels. ICP increases maternal and fetal morbidities. This study was designed to determine the association of maternal and fetal complications and serum bile acid levels.Material and method:Maternal and fetal characteristics were analyzed from the medical records of 61 patients who gave birth following a pregnancy complicated with ICP between 2009 and 2013.Results:Eighty seven percent of 61 cases were singletons, and 13% of them were twins. Mean SBA level was 36 μmol/L. Preterm birth rate among singletons and twin pregnancies were 24.5% and 62.5%, respectively. Mean SBA level in preterm birth group was statistically higher with respect to the term birth group (100.8 μmol/L and 25.61 μmol/L, respectively; p=0.001). No perinatal mortality associated with ICP was detected in the study group.Conclusion:Pregnant women with the ICP compose high-risk group in regard to fetal and maternal risks. Close follow-up of these patients is required due to increased risks such as preterm delivery, meconium staining and fetal death.

The frequency of feto-maternal complications in patients with intrahepatic cholestasis of pregnancy.

“…However some other studies found to have different results like 77% patients had preterm deliveries that were spontaneous deliveries and not iatrogenic. 21 Similarly Geenes et al reported that frequency of prematurity in patients having singleton fetuses with severe ICP increased up-to 5.3 times when we compared it to compared to the singletons fetuses without ICP. 22 and the results of our study also affirm these results.…”

Ursodeoxycholic acid improves pregnancy outcome in patients with intrahepatic cholestasis during pregnancy

“…[ 23 , 24 ] At the same time, the high concentration of bile acid in the blood of ICP patients will lead to the obstruction of bile acid excretion in the fetus, causing hypercholic acidemia, vasospasm, decreased blood flow, less oxygen exchange, fetal distress, and damage of fetal viscera function. [ 25 , 26 ] High bile acid levels can also lead to a disturbance in fetal steroid metabolism, resulting in high dehydroepiandrosterone expression and the formation of large amounts of estradiol through the placenta, leading to preterm labor. [ 27 , 28 ] In addition, too much bile acid in the fetus can stimulate intestinal smooth muscle contraction, increase intestinal peristalsis, and defecate frequently into the amniotic fluid, eventually resulting in amniotic fluid pollution.…”

A rare case of early onset intrahepatic cholestasis of pregnancy

“…13 The risk of foetal complication is statistically increased at bile acids levels ≥ 40 micromol/ltr. 14 ICP affected pregnant women are at increased risk of developing PE, GDM, chorioamnionitis, PPh, CS. 15 These women may be associated with subsequent development of hepatobiliary cancer, DM, thyroid disease, Cohn's disease and other immune mediated disorders.…”