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Liu X, Xin S, Xu F, Zhou M, Xiong Y, Zeng Y, Zeng X, Zou Y. Single-cell RNA sequencing reveals heterogeneity and differential expression of the maternal-fetal interface during ICP and normal pregnancy. J Matern Fetal Neonatal Med 2024; 37:2361278. [PMID: 38835155 DOI: 10.1080/14767058.2024.2361278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/24/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVE Intrahepatic cholestasis of pregnancy (ICP) can cause adverse perinatal outcomes. Previous studies have demonstrated that the placenta of an ICP pregnancy differs in morphology and gene expression from the placenta of a normal pregnancy. To date, however, the genetic mechanism by which ICP affects the placenta is poorly understood. Therefore, the aim of this study was to investigate the differences in main cell types, gene signatures, cell ratio, and functional changes in the placenta between ICP and normal pregnancy. METHODS Single-cell RNA sequencing (scRNA-seq) technology was used to detect the gene expression of all cells at the placental maternal-fetal interface. Two individuals were analyzed - one with ICP and one without ICP. The classification of cell types was determined by a graph-based clustering algorithm. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed using the R software phyper () function and DAVID website. The differentially expressed genes (DEGs) encoding transcription factors (TFs) were identified using getorf and DIAMOND software. RESULTS We identified 14 cell types and 22 distinct cell subtypes that showed unique functional properties. Additionally, we found differences in the proportions of fibroblasts 1, helper T (Th) cells, extravillous trophoblasts, and villous cytotrophoblasts, and we observed heterogeneity of gene expression between ICP and control placentas. Furthermore, we identified 263 DEGs that belonged to TF families, including zf-C2H2, HMGI/HMGY, and Homeobox. In addition, 28 imprinted genes were preferentially expressed in specific cell types, such as PEG3 and PEG10 in trophoblasts as well as DLK1 and DIO3 in fibroblasts. CONCLUSIONS Our results revealed the differences in cell-type ratios, gene expression, and functional changes between ICP and normal placentas, and heterogeneity was found among cell subgroups. Hence, the imbalance of various cell types affects placental activity to varying degrees, indicating the complexity of the cell networks that form the placental tissue system, and this alteration of placental function is associated with adverse events in the perinatal period.
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Affiliation(s)
- Xianxian Liu
- Key Laboratory of Women's Reproductive Health of Jiangxi Province, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Siming Xin
- Key Laboratory of Women's Reproductive Health of Jiangxi Province, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Fangping Xu
- Key Laboratory of Women's Reproductive Health of Jiangxi Province, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Mengni Zhou
- Key Laboratory of Women's Reproductive Health of Jiangxi Province, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Ying Xiong
- Key Laboratory of Women's Reproductive Health of Jiangxi Province, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Yang Zeng
- Key Laboratory of Women's Reproductive Health of Jiangxi Province, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Xiaoming Zeng
- Key Laboratory of Women's Reproductive Health of Jiangxi Province, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Yang Zou
- Key Laboratory of Women's Reproductive Health of Jiangxi Province, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, China
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Zhang P, Tan Z, Li C, Han Z, Zhou J, Yin Y. The correlation between serum total bile acid and adverse perinatal outcomes in pregnant women with intrahepatic cholestasis of pregnancy (ICP) and non-ICP hypercholanemia of pregnancy. Ann Med 2024; 56:2331059. [PMID: 38515230 PMCID: PMC10962286 DOI: 10.1080/07853890.2024.2331059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 02/23/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The association between excessive serum total bile acid (TBA) and adverse perinatal outcomes in individuals with non-intrahepatic cholestasis of pregnancy (non-ICP) hypercholanemia has not been determined, and it is unclear if this link is similar to that observed in patients with ICP. OBJECTIVE To examine the adverse perinatal outcomes in two specific subcategories: those with ICP and those with non-ICP, including individuals with liver disease and asymptomatic hypercholanemia of pregnancy (AHP), at different levels of TBA. Investigate the correlation between TBA levels and adverse perinatal outcomes of ICP, liver disease, and AHP. METHODS From 2013 to 2021, pregnant women with excessive TBA levels were taken from the electronic medical record database of our hospital and categorized into three groups: ICP (n = 160), liver disease (n = 164), and AHP (n = 650). This was done as part of a retrospective cohort research project. Multivariable regression and subgroup analyses were performed to examine the association between TBA levels and adverse perinatal outcomes in each group. RESULTS The study found no significant differences in adverse perinatal outcomes between the ICP and liver disease groups at different TBA levels. However, at moderate TBA levels, both groups had a higher risk of adverse perinatal outcomes than the AHP group (p < 0.017). Among liver disease cases with TBA ≥ 100µmol/L, three cases of perinatal deaths (6.67%) associated with moderate-to-severe acute hepatitis occurred between 27 and 33 weeks of gestation. A 59% higher chance of perinatal death was found for every 10 µmol/L rise in TBA, even after significant variables and confounders were taken into account (adjusted odds ratio (aOR) = 1.59; 95% confidence interval (CI): 1.06-2.40; p = 0.03). CONCLUSIONS If a pregnant woman has moderate-to-severe liver disease and TBA ≥ 100µmol/L, preterm termination of pregnancy (before 34 weeks) may be considered.
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Affiliation(s)
- Peizhen Zhang
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhangmin Tan
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Chuo Li
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhenyan Han
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jin Zhou
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yuzhu Yin
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Mao JY, Luo S, Wang L, Chen Y, Zhou Q, Yang CY, Xiang X, Wang DP, Zuo HM, Liu TH, Wen L, Qu SM, Hou T. Impact factors and obstetric outcomes of preeclampsia in twin pregnancies by prepregnancy body mass index: a six-year retrospective cohort study. J Matern Fetal Neonatal Med 2024; 37:2345294. [PMID: 38658184 DOI: 10.1080/14767058.2024.2345294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES Among many risk factors for preeclampsia (PE), prepregnancy body mass index (BMI) is one of few controllable factors. However, there is a lack of stratified analysis based on the prepregnancy BMI. This study aimed to determine the influencing factors for PE and assess the impact of PE on obstetric outcomes in twin pregnancies by prepregnancy BMI. METHODS This was a retrospective cohort study between January 1, 2017, and December 31, 2022, in Southwest China. Impact factors and associations between PE and obstetric outcomes were analyzed separately for twin pregnancies with prepregnancy BMI < 24kg/m2 (non-overweight group) and BMI ≥ 24kg/m2 (overweight group). RESULTS In total, 3602 twin pregnancies were included, of which, 672 women were allocated into the overweight group and 11.8% of them reported with PE; 2930 women were allocated into the non-overweight group, with a PE incidence of 5.6%. PE had a negative effect on birthweight and increased the incidence of neonatal intensive care unit admission in both the overweight and non-overweight groups (43.0% vs. 28.0%, p = .008; 45.7% vs. 29.1%, p < .001). Among overweight women, PE increased the proportion of postpartum hemorrhage (15.2% vs. 4.4%, p < .001). After adjustments, multivariate regression analysis showed that excessive gestational weight gain (aOR = 1.103, 95% CI: 1.056-1.152; aOR = 1.094, 95% CI: 1.064-1.126) and hypoproteinemia (aOR = 2.828, 95% CI: 1.501-5.330; aOR = 6.932, 95% CI: 4.819-9.971) were the shared risk factors for PE in both overweight and non-overweight groups. In overweight group, in vitro fertilization was the other risk factor (aOR = 2.713, 95% CI: 1.183-6.878), whereas dichorionic fertilization (aOR = 0.435, 95% CI: 0.193-0.976) and aspirin use during pregnancy (aOR = 0.456, 95% CI: 0.246-0.844) were protective factors. Additionally, anemia during pregnancy (aOR = 1.542, 95% CI: 1.090-2.180) and growth discordance in twins (aOR = 2.451, 95% CI: 1.215-4.205) were connected with an increased risk of PE only in non-overweight twin pregnancies. CONCLUSIONS Both discrepancy and similarity of impact factors on developing PE were found between overweight and non-overweight twin pregnancies in this study. However, the dosage and initiation time of aspirin, as well as twin chorionicity on the occurrence of PE in two subgroups, are still debated.
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Affiliation(s)
- Jia-Yi Mao
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, (Women and Children's Hospital of Chongqing Medical University), Chongqing, China
| | - Shuang Luo
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, (Women and Children's Hospital of Chongqing Medical University), Chongqing, China
| | - Lan Wang
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, (Women and Children's Hospital of Chongqing Medical University), Chongqing, China
| | - Ya Chen
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, (Women and Children's Hospital of Chongqing Medical University), Chongqing, China
| | - Qing Zhou
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, (Women and Children's Hospital of Chongqing Medical University), Chongqing, China
| | - Chun-Yan Yang
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, (Women and Children's Hospital of Chongqing Medical University), Chongqing, China
| | - Xue Xiang
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, (Women and Children's Hospital of Chongqing Medical University), Chongqing, China
| | - Da-Ping Wang
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, (Women and Children's Hospital of Chongqing Medical University), Chongqing, China
| | - Hong-Mei Zuo
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, (Women and Children's Hospital of Chongqing Medical University), Chongqing, China
| | - Tai-Hang Liu
- The Joint International Research Laboratory of Reproduction and Development, Ministry of Education, Chongqing, China
| | - Li Wen
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, (Women and Children's Hospital of Chongqing Medical University), Chongqing, China
| | - Si-Meng Qu
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, (Women and Children's Hospital of Chongqing Medical University), Chongqing, China
| | - Ting Hou
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, (Women and Children's Hospital of Chongqing Medical University), Chongqing, China
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Brenøe JE, van Hoorn EGM, Beck L, Bulthuis M, Bezemer RE, Gordijn SJ, Schoots MH, Prins JR. Altered placental macrophage numbers and subsets in pregnancies complicated with intrahepatic cholestasis of pregnancy (ICP) compared to healthy pregnancies. Placenta 2024; 153:22-30. [PMID: 38810541 DOI: 10.1016/j.placenta.2024.05.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/29/2024] [Accepted: 05/15/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION Intrahepatic cholestasis of pregnancy (ICP) can result in adverse outcomes for both mother and fetus. Inflammatory (M1 subset) or anti-inflammatory (M2 subset) macrophage polarisation is associated with various complications of pregnancy. However, the influence of ICP on macrophage numbers and polarisation remains unknown. This study analyses macrophage density and distribution in placentas of patients with ICP compared to controls. Clinical parameters were correlated to macrophage distribution and ursodeoxycholic acid use (UDCA). METHODS This study included routinely collected placental tissue samples of 42 women diagnosed with ICP and of 50 control pregnancies. Immunohistochemical staining was performed on placental tissue using CD68 antibody as a pan-macrophage marker, CD206 antibody as an M2 and HLA-DR antibody as an M1 macrophage marker. Macrophage density (cells/mm2) and distribution (CD206+/CD68+ or CD206+/CD68+HLA-DR+) in both decidua (maternal tissue) and villous parenchyma (fetal tissue) were compared between groups. Macrophage density and distribution were correlated to clinical parameters for ICP patients. RESULTS The density of CD68+ macrophages differed significantly between groups in villous parenchyma. In both decidua and villous parenchyma, CD206+/CD68+ ratio was significantly lower in ICP patients compared to controls (p = 0.003 and p=<0.001, respectively). No difference was found based on UDCA use or in CD68+HLA-DR+ cell density. Significant correlations were found between macrophage density and peak serum bile acids and liver enzymes. DISCUSSION In ICP patients, an immune shift was observed in both decidual and villous tissue, indicated by a lower CD206+/CD68+ ratio. ICP seems to affect placental tissue, however more research is required to understand its consequences.
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Affiliation(s)
- J E Brenøe
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - E G M van Hoorn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - L Beck
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - M Bulthuis
- Department of Pathology and Medical Biology, Division of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - R E Bezemer
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - S J Gordijn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - M H Schoots
- Department of Pathology and Medical Biology, Division of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - J R Prins
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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Golbasi H, Bayraktar B, Golbasi C, Omeroglu I, Adiyaman D, Alkan KO, Ozdemir TR, Ozer OK, Ozyilmaz B, Ekin A. Association between fetal fraction of cell-free DNA and adverse pregnancy outcomes. Arch Gynecol Obstet 2024; 310:1037-1048. [PMID: 38441603 DOI: 10.1007/s00404-024-07443-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/16/2024] [Indexed: 07/19/2024]
Abstract
PURPOSE To determine the association between fetal fraction (FF) levels in cell-free fetal DNA (cffDNA) testing and adverse pregnancy outcomes. METHODS This retrospective cohort study, conducted at a single center, involved 2063 pregnant women with normal 1st and 2nd trimester non-invasive prenatal test (NIPT) results between 2016 and 2021. Pregnancy outcomes were examined by determining the < 4% and < 5th percentile (3.6%) cut-off values for low fetal fraction (LFF). Pregnancy outcomes were also examined by dividing the FF into population-based quartiles. Adverse pregnancy outcomes were pregnancy-induced hypertensive diseases (PIHD), gestational diabetes mellitus (GDM), spontaneous preterm birth (PTB), intrahepatic cholestasis of pregnancy (ICP), small for gestational age (SGA), large for gestational age (LGA), low birth weight (LBW), macrosomia, and 1st and 5th minutes low APGAR scores (< 7). RESULTS PIHD was significantly higher in LFF (< 4% and < 5th percentile) cases (p = 0.015 and p < 0.001, respectively). However, in population-based quartiles of FF, PIHD did not differ significantly between groups. Composite adverse maternal outcomes were significantly higher in the FF < 4% group (p = 0.042). When analyzes were adjusted for maternal age, BMI, and gestational age at NIPT, significance was maintained at < 4%, < 5th percentile LFF for PIHD, and < 4% LFF for composite adverse maternal outcomes. However, there was no significant relationship between LFF with GDM, ICP and PTB. Additionally, there was no significant association between low APGAR scores, SGA, LGA, LBW, macrosomia, and LFF concerning neonatal outcomes. CONCLUSION Our study showed that LFF in pregnant women with normal NIPT results may be a predictor of subsequent PIHD.
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Affiliation(s)
- Hakan Golbasi
- Division of Perinatology, Department of Obstetrics and Gynecology, Bakircay University Cigli Education and Research Hospital, Yeni District., 8780/1 St., Cigli, Izmir, Izmir, Türkiye.
- Division of Perinatology, Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Türkiye.
| | - Burak Bayraktar
- Division of Perinatology, Department of Obstetrics and Gynecology, University of Health Sciences Ankara Etlik City Hospital, Ankara, Türkiye
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Türkiye
| | - Ceren Golbasi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Izmir Tinaztepe University, Izmir, Türkiye
| | - Ibrahim Omeroglu
- Division of Perinatology, Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Türkiye
| | - Duygu Adiyaman
- Division of Perinatology, Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Türkiye
- Department of Obstetrics and Gynecology, Ulm University Hospital, Ulm, Germany
| | - Kaan Okan Alkan
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Türkiye
| | - Taha Resid Ozdemir
- Department of Genetics, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Türkiye
| | - Ozge Kaya Ozer
- Department of Genetics, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Türkiye
| | - Berk Ozyilmaz
- Department of Genetics, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Türkiye
| | - Atalay Ekin
- Division of Perinatology, Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Türkiye
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Zhou Q, Yuan Y, Wang Y, He Z, Liang Y, Qiu S, Chen Y, He Y, Lv Z, Liu H. The severity of intrahepatic cholestasis during pregnancy increases risks of adverse outcomes beyond stillbirth: evidence from 15,826 patients. BMC Pregnancy Childbirth 2024; 24:476. [PMID: 38997626 PMCID: PMC11241884 DOI: 10.1186/s12884-024-06645-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/17/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND What kinds of fetal adverse outcomes beyond stillbirth directly correlate to the severity of intrahepatic cholestasis during pregnancy (ICP) remained tangled. Herein, we conducted a retrospective cohort study and a dose-response meta-analysis to speculate the association between the severity of ICP and its adverse outcomes. METHODS We retrospectively collected a cohort of ICP patients from electronic records from Guangzhou Women and Children's Medical Center between Jan 1st, 2018, and Dec 31st, 2022. Also, we searched PubMed, Cochrane, Embase, Scopus, and Web of Science to extract prior studies for meta-analysis. The Kruskal-Wallis test, a one-way or two-way variants analysis (ANOVA), and multi-variant regression are utilized for cohort study. One stage model, restricted cubic spline analysis, and fixed-effect model are applied for dose-response meta-analysis. The data analysis was performed using the R programme. RESULTS Our cohort included 1,289 pregnant individuals, including 385 mild ICP cases, 601 low moderate ICP cases, 282 high moderate ICP cases, and 21 severe ICP cases. The high moderate bile acid levels were correlated to preterm birth [RR = 2.14, 95%CI 1.27 to 3.62), P < 0.01], and preterm premature rupture of membranes [RR = 0.34, 95%CI 0.19 to 0.62), P < 0.01]. We added our cases to cases reported by other studies included in the meta-analysis. There were 15,826 patients included in dose-response meta-analysis. The severity of ICP was associated with increased risks of stillbirth, spontaneous preterm birth, iatrogenic preterm birth, preterm birth, admission to neonatal intensive care unit, and meconium-stained fluid (P < 0.05). CONCLUSIONS Our study shows the correlation between the severity of ICP and the ascending risks of stillbirth, preterm birth, and meconium-stained fluid, providing new threshold TBA levels. PROSPERO REGISTRATION NUMBER CRD42023472634.
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Affiliation(s)
- Qiulun Zhou
- Clinical Data Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yi Yuan
- School of Pediatrics, Guangzhou Medical University, Guangzhou, China
| | - Yuying Wang
- School of Pediatrics, Guangzhou Medical University, Guangzhou, China
| | - Zhuoqi He
- School of Pediatrics, Guangzhou Medical University, Guangzhou, China
| | - Yannei Liang
- School of Pediatrics, Guangzhou Medical University, Guangzhou, China
| | - Suyi Qiu
- School of Pediatrics, Guangzhou Medical University, Guangzhou, China
| | - Yiting Chen
- School of Pediatrics, Guangzhou Medical University, Guangzhou, China
| | - Yiru He
- School of Pediatrics, Guangzhou Medical University, Guangzhou, China
| | - Zi Lv
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
| | - Huishu Liu
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
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Avsar HA, Atlıhan U, Ata C, Erkılınc S. Intrahepatic cholestasis of pregnancy and its association with preeclampsia and gestational diabetes: a retrospective analysis. Arch Gynecol Obstet 2024; 310:221-227. [PMID: 38625544 DOI: 10.1007/s00404-024-07507-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/03/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE To evaluate maternal and neonatal outcomes in patients with intrahepatic cholestasis of pregnancy (ICP). METHODS Patients who gave birth in our hospital between January 2018 and March 2022 were retrospectively reviewed from the hospital database and patient file records. The study comprised 1686 patients, 54 in the ICP group and 1632 controls. Patients who had ICP after 20 weeks of gestation and were monitored and delivered at our facility were enrolled. Maternal demographic and obstetric characteristics data were examined. Perinatal outcomes were also assessed. Logistic regression analysis was used to determine adverse maternal outcomes. RESULTS The mean age was 29 years. ART, GDM, and preeclampsia were significantly higher in the ICP group. The mean serum bile acid level was 19.3 ± 3 μmol/L in the ICP group. There was a higher risk of GDM and pre-eclampsia in women with ICP compared with those without and a significant association between ICP and adverse perinatal outcomes. There was a statistically significant relation between the presence of ICP and spontaneous preterm delivery, iatrogenic preterm delivery, 5th-minute Apgar scores < 7, and NICU requirement. No significant relationship was found between the presence of ICP and SGA and meconium. There was a significant relationship between the presence of ICP, mode of delivery, and PPH (p < 0.05). Those with ICP had a lower gestational week and birth weight, and higher rates of cesarean delivery and PPH. CONCLUSION ICP should prompt close monitoring and management to mitigate the potential exacerbation of adverse outcomes, including preeclampsia, GDM, and preterm birth.
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Affiliation(s)
- Huseyin Aytug Avsar
- Department of Obstetrics and Gynecology, Izmir Demokrasi University, Buca Seyfi Demirsoy Training and Research Hospital, Izmir, Turkey
| | | | - Can Ata
- Department of Obstetrics and Gynecology, Izmir Demokrasi University, Buca Seyfi Demirsoy Training and Research Hospital, Izmir, Turkey.
| | - Selcuk Erkılınc
- Department of Obstetrics and Gynecology, Izmir Demokrasi University, Buca Seyfi Demirsoy Training and Research Hospital, Izmir, Turkey
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Saadi R, Saban A, Weintraub AY, Yardeni D, Eshkoli T. The association between aspartate aminotransferase (AST) to platelets (PLT) ratio (APRI) and the development of intrahepatic cholestasis in pregnancy and other related complications. Arch Gynecol Obstet 2024; 310:427-432. [PMID: 38355761 DOI: 10.1007/s00404-024-07383-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/07/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE To assess the association between aspartate aminotransferase (AST) to platelet count ratio index (APRI score), during the first and third trimesters of pregnancy and the development of intrahepatic cholestasis in pregnancy (ICP). METHODS Case-control study was conducted. The study included patients diagnosed with ICP by elevated bile acids (n = 118) and a control group of women with symptoms such as elevated liver enzymes or pruritus with normal level of bile acids (n = 127) who attended a large tertiary teaching medical center between the years 2014 and 2021. The groups were compared in terms of obstetrical characteristics, perinatal outcomes, first- and third-trimester laboratory tests, and APRI scores during the first and third trimester. A receiver operating characteristic (ROC) analysis was performed to determine the APRI score cutoff value that could predict ICP. RESULTS The third-trimester APRI scores of patients with ICP were significantly higher than those of the control group (P < 0.001). The ROC analysis revealed that the cutoff value for the APRI score was 0.42 with 65.3% sensitivity and 73.2% specificity. CONCLUSION Our results suggest that the third-trimester APRI score is positively associated with ICP.
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Affiliation(s)
- Razan Saadi
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Alla Saban
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - David Yardeni
- Department of Gastroenterology and Liver Diseases, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Eshkoli
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Li X, Kong Y, Ren Y, Li Y, Xu J, Zhan Y, Zhou S, Yang F, Xu T, Wang X. The impact of maternal intrahepatic cholestasis during pregnancy on the growth trajectory of offspring: a population-based nested case‒control cohort study. BMC Pregnancy Childbirth 2024; 24:413. [PMID: 38849722 PMCID: PMC11157880 DOI: 10.1186/s12884-024-06559-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/02/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Intrahepatic cholestasis of pregnancy (ICP) is associated with an increased risk of adverse fetal outcomes, yet its influence on offspring growth remains unclear. Our study dynamically tracks growth rates in children from ICP and healthy mothers and investigates the link between maternal liver function and developmental abnormalities in offspring. METHOD Our case‒control study involved 97 women with ICP and 152 with uncomplicated pregnancies nested in a cohort of their offspring, including 50 from the ICP group and 87 from the uncomplicated pregnancy group. We collected pediatric growth and development data, with a maximum follow-up duration of 36 months. Stratified analyses of children's height, weight, and head circumference were conducted, and Spearman's rank correlation was applied to examine the relationships between maternal serological markers and pediatric growth metrics. RESULT Maternal liver and renal functions, along with serum lipid profiles, significantly differed between the ICP and normal groups. In the ICP group, the offspring showed elevated alanine aminotransferase (ALT), direct bilirubin (DBIT), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and apolipoprotein B (APOB) levels. Notably, the length-for-age z score (LAZ), weight-for-age z score (WAZ), and head circumference-for-age z score (HCZ) were lower in ICP offspring compared with those from normal pregnancies within the 1- to 12-month age range (P < 0.05). However, no significant differences in LAZ, weight-for-length z score (WLZ), BMI-for-age z score (BAZ), or HCZ were observed between groups in the 13- to 36-month age range. Maternal maximum lactate dehydrogenase (LDH) and total bile acids (TBA) levels during pregnancy were inversely correlated with LAZ and WAZ in the first year. Furthermore, offspring of mothers with ICP exhibited a greater incidence of stunting (24% vs. 6.9%, P = 0.004) and abnormal HCZ (14% vs. 3.7%, P = 0.034). CONCLUSIONS Growth disparities in offspring of ICP-affected pregnancies were most significant within the 1- to 12-month age range. During this period, maximum maternal LDH and TBA levels were negatively correlated with LAZ and WAZ values of offspring. The observation of similar growth rates between ICP and control group offspring from 13 to 36 months suggested catch-up growth in the ICP group.
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Affiliation(s)
- Xueqi Li
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Renmin Nan Road, Chengdu, 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China
| | - Yao Kong
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Renmin Nan Road, Chengdu, 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China
| | - Yuxin Ren
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Renmin Nan Road, Chengdu, 610041, Sichuan, China
| | - Yaqian Li
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Renmin Nan Road, Chengdu, 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China
| | - Jinfeng Xu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Renmin Nan Road, Chengdu, 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China
| | - Yongchi Zhan
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Renmin Nan Road, Chengdu, 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China
| | - Shu Zhou
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Renmin Nan Road, Chengdu, 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China
| | - Fan Yang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China
- Department of Child Health, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Tingting Xu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Renmin Nan Road, Chengdu, 610041, Sichuan, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China.
| | - Xiaodong Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Renmin Nan Road, Chengdu, 610041, Sichuan, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China.
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10
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Feng F, Li J, Liao J, Qin S, Liu Y, Che X, Zhou Y, Jiang D, Xiao H, Chen A, Shao Y. Associations of clinical subtypes and bile acid levels of intrahepatic cholestasis of pregnancy with pregnancy outcomes. Sci Rep 2024; 14:12185. [PMID: 38806569 PMCID: PMC11133304 DOI: 10.1038/s41598-024-63183-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 05/27/2024] [Indexed: 05/30/2024] Open
Abstract
Intrahepatic cholestasis of pregnancy (ICP) can lead to many adverse pregnancy outcomes, and the influencing factors remain unclear at present. This study retrospectively analyzed clinical data from 1815 pregnant women with ICP and evaluated the relationship between ICP subtypes, gestational age at onset, and pregnancy outcomes. The results of this study show that during pregnancy, the levels of biochemical indicators (TBA, DBIL and ALT) in the serum of pregnant women initially diagnosed with subtypes of ICP were noted to constantly change, and the subtype of ICP and its severity also changed. The incidence of adverse pregnancy outcomes [meconium-stained amniotic fluid (MSAF), NICU transfer, Apgar score ≤ 7 at 1 min, and preterm birth] in patients with ICP1 (icteric type) was significantly higher than for patients with ICP2, ICP3 or ICP4. The preterm birth rate of early-onset ICP was higher than that of late-onset ICP in ICP1 and ICP3 subtypes. In conclusion, the outcome of pregnancy in women with ICP is closely related to the serum TBA level and ICP subtype, which should be recognized in the clinic.
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Affiliation(s)
- Fan Feng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Juhong Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Department of Obstetrics and Gynecology, Yubei District Maternal and Child Health Hospital, Chongqing, China
| | - Junqun Liao
- Department of Experiment, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shiyi Qin
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yaling Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Department of Obstetrics and Gynecology, Yubei District Maternal and Child Health Hospital, Chongqing, China
| | - Xian Che
- Department of Obstetrics and Gynecology, Yubei District Maternal and Child Health Hospital, Chongqing, China
| | - Yanjun Zhou
- Department of Obstetrics and Gynecology, Yubei District Maternal and Child Health Hospital, Chongqing, China
| | - Dan Jiang
- Department of Obstetrics and Gynecology, Yubei District Maternal and Child Health Hospital, Chongqing, China
| | - Huiqin Xiao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Aixing Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yong Shao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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11
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Silver RM, Reddy U. Stillbirth: we can do better. Am J Obstet Gynecol 2024:S0002-9378(24)00628-8. [PMID: 38789073 DOI: 10.1016/j.ajog.2024.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/23/2024] [Accepted: 05/20/2024] [Indexed: 05/26/2024]
Abstract
Stillbirth is far too common, occurring in millions of pregnancies per year globally. The rate of stillbirth (defined as death of a fetus prior to birth at 20 weeks' gestation or more) in the United States is 5.73 per 1000. This is approximately 1 in 175 pregnancies accounting for about 21,000 stillbirths per year. Although rates are much higher in low-income countries, the stillbirth rate in the United States is much higher than most high resource countries. Moreover, there are substantial disparities in stillbirth, with rates twice as high for non-Hispanic Black and Native Hawaiian or Other Pacific Islanders compared to non-Hispanic Whites. There is considerable opportunity for reduction in stillbirths, even in high resource countries such as the United States. In this article, we review the epidemiology, risk factors, causes, evaluation, medical and emotional management, and prevention of stillbirth. We focus on novel data regarding genetic etiologies, placental assessment, risk stratification, and prevention.
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Affiliation(s)
- Robert M Silver
- Departments of Obstetrics and Gynecology, Divisions of Maternal Fetal Medicine, University of Utah, Salt Lake City, UT.
| | - Uma Reddy
- Departments of Obstetrics and Gynecology, Divisions of Maternal Fetal Medicine, Columbia University, New York, NY
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12
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Guerra M, Montaño I, Haye MT, Toro V, Maiz N. Fetal PR Interval in Pregnancies with Intrahepatic Cholestasis of Pregnancy: A Case-Control Study. Am J Perinatol 2024; 41:e2964-e2969. [PMID: 37774745 DOI: 10.1055/a-2184-0242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
OBJECTIVE This study had three purposes: first, to explore differences in fetal cardiac function in patients with and without intrahepatic cholestasis of pregnancy (ICP) based on PR interval (the interval between the beginning of the atrial contraction and the beginning of the ventricular contraction). Second, to explore a potential correlation between PR interval and bile acid levels in pregnant women with ICP. Third, to study changes in PR interval of fetuses from pregnant women with ICP after administration of ursodeoxycholic acid (UDCA). STUDY DESIGN This was a prospective observational case-control study. ICP was defined as palmar plantar pruritus of nocturnal predominance for more than 1 week associated with a total bile acid level >10 μmol/L. Control cases were women with pregnancies scheduled for induction or elective cesarean section at term. RESULTS One hundred and ten women with ICP and 72 controls were included in the study. Median gestational age at inclusion was 35.9 weeks. Median PR interval was significantly longer in fetuses of women with ICP (122 vs. 102 ms, p < 0.001). There was a significant correlation between bile acid levels and PR interval (rho = 0.723, p < 0.001). In 22 fetuses, the median PR interval decreased significantly following UDCA administration (134 vs. 118 ms, p = 0.004). CONCLUSION PR interval is longer in fetuses of women with ICP. PR interval was significantly correlated with bile acid levels, and administration of UDCA significantly reduced PR interval. KEY POINTS · Differences in fetal cardiac function in patients with and without intrahepatic cholestasis.. · PR interval and bile acid levels in pregnant women with intrahepatic cholestasis.. · Changes in PR interval of fetuses from pregnant women with ICP after use of UDCA..
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Affiliation(s)
- Manuel Guerra
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Clínico San José, Santiago, Chile
- Department of Perinatology, Clínica Redsalud Vitacura, Santiago, Chile
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Ignacio Montaño
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Clínico San José, Santiago, Chile
- Department of Ultrasonography, Clínica Indisa, Santiago, Chile
| | - María T Haye
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Clínico San José, Santiago, Chile
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Clínica Alemana, Santiago, Chile
| | - Victoria Toro
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Clínico San José, Santiago, Chile
| | - Nerea Maiz
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
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13
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Hamud A, Cohen MJ, Hochner-Celnikier D, Bar-Oz B, Ackerman Z. Gradual dosing of ursodeoxycholic acid in mothers with intrahepatic cholestasis of pregnancy may improve composite neonatal outcome. Ann Hepatol 2024; 29:101490. [PMID: 38403070 DOI: 10.1016/j.aohep.2024.101490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/10/2023] [Accepted: 01/03/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION AND OBJECTIVES Intrahepatic cholestasis of pregnancy (ICP) is often accompanied by fetal and maternal complications. MATERIALS AND METHODS Retrospective review of the clinical course of women with ICP and their neonates treated at our medical center over a 10-year period. Special attention was paid to the maternal and neonatal response to 2 different modes of ursodeoxycholic acid (UDCA) administration. RESULTS Neonates of mothers with high total bile acid levels had a poorer composite neonatal outcome. Twenty-seven women who presented at an advanced stage of their pregnancies did not receive UDCA. UDCA was administered in 2 modes: either a full dose at admission (76 women) or a gradually increasing dose until the desired dosage was reached (25 women). The mean gestational age at delivery for the 94 neonates that were exposed to full UDCA dose was the lowest (36±2.3 weeks for the full dose, 37±1.4 weeks for the 30 neonates from the gradually increasing dose, 38±1.6 weeks for the 29 neonates from the no treatment group, p<0.001). The group of neonates that were exposed to full UDCA dose had the highest rate of unfavorable composite neonatal outcome (53% for full dose, 30% for gradually increasing dose, 24% for the no treatment group, p=0.006). CONCLUSIONS Compared to the administration of a full UDCA dose, the administration of a gradually increasing dose of UDCA may be associated with a greater gestational age at delivery and fewer events of unfavorable composite neonatal outcomes. These novel findings should be retested prospectively in a large cohort of patients.
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Affiliation(s)
- Amir Hamud
- Department of Medicine, Hadassah-Hebrew University Medical Center and the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Matan J Cohen
- Clalit Health Services, Jerusalem District, affiliated to the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Drorith Hochner-Celnikier
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center and the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Benjamin Bar-Oz
- Department of Neonatology, Hadassah-Hebrew University Medical Center and the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Zvi Ackerman
- Department of Medicine, Hadassah-Hebrew University Medical Center and the Hebrew University-Hadassah Medical School, Jerusalem, Israel.
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14
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Cui J, Zhai Q, Chen M, Yang Z. Genetically predicted lipids mediate the association between intrahepatic cholestasis of pregnancy and cardiovascular disease. Front Cardiovasc Med 2024; 11:1401010. [PMID: 38745758 PMCID: PMC11091286 DOI: 10.3389/fcvm.2024.1401010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction Intrahepatic cholestasis of pregnancy (ICP), the most prevalent liver disorder specific to pregnancy, affects approximately 1.5%-4% of pregnancies. However, the influence of ICP on cardiovascular disease (CVD), including hypertension (HTN) and coronary artery disease (CAD), has not been thoroughly investigated. Methods This study explores the causal relationship between ICP and CVD (HTN, CAD) using Mendelian Randomization (MR). Utilizing summary-level data from Genome-Wide Association Studies (GWAS), we applied the inverse-variance weighted (IVW) method, supplemented by sensitivity and reverse MR analyses, to ascertain robustness. Results Our findings reveal significant causal links, indicating ICP notably increases the risk of CVD (P = 0.001), hypertension (HTN, P = 0.024), and coronary artery disease (CAD, P = 0.039). A two-step MR analysis highlighted the mediation role of lipid profiles, with LDL, TC, and Apo-B contributing to increased CVD risk by 25.5%, 12.2%, and 21.3%, respectively. Additionally, HTN was identified as a mediator in the ICP-CAD association, accounting for a 14.5% mediation effect. Discussion The results underscore the genetic predisposition of ICP to elevate CVD risk and the critical mediating role of lipid levels, emphasizing the need for vigilant lipid monitoring and early intervention in individuals with ICP.
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Affiliation(s)
- Ji Cui
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qilong Zhai
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mengjie Chen
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhu Yang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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15
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Malarkiewicz P, Nowacka U, Januszaniec A, Mankiewicz A, Kozłowski S, Issat T. Intrahepatic Cholestasis of Pregnancy during COVID-19 Pandemic. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:676. [PMID: 38674322 PMCID: PMC11052128 DOI: 10.3390/medicina60040676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Intrahepatic cholestasis of pregnancy (ICP) stands as one of the most prevalent concerns in maternal-fetal medicine, presenting a significant risk to fetal health and often associated with liver dysfunction. Concurrently, the coronavirus-19 (COVID-19) infection can lead to hepatic cell injury through both direct and indirect pathways. Hypothetically, these two conditions may coincide, influencing each other. This study aimed to comparatively assess the incidence and severity of ICP before and during the COVID-19 pandemic. Methods: A retrospective cohort study was conducted, comparing the incidence and severity of ICP between January 2018 and February 2020 (pre-COVID-19 period) and March 2020 to March 2022 (COVID-19 period) across two hospitals, encompassing 7799 deliveries. The diagnosis of ICP was established using the ICD-10 code and defined as total bile acids (BA) levels ≥ 10 μmol/L. Statistical analysis included descriptive statistics, Chi-square and Mann-Whitney U tests, as well as multiple or logistic regression analysis. Results: A total of 226 cases of ICP were identified. The incidence of mild cholestasis (BA < 40 μmol/L) was lower during the pandemic compared to before (3% before versus 2%, p < 0.05), while the incidence of moderate and severe ICP remained unchanged (0.6% before vs. 0.4%, p = 0.2). Overall, the total incidence of ICP was lower during the pandemic (3.6% before versus 2.4%, p = 0.01). No significant differences were observed in severity (as defined by BA and liver function test levels), rates of caesarean section, or neonatal birth weights. Conclusions: During the COVID-19 pandemic, the total incidence of ICP appeared to be lower. However, this reduction was primarily observed in cases of mild ICP, potentially indicating challenges in detection or reduced access to medical services during this period. The incidence of moderate and severe ICP remained unchanged, suggesting that these forms of the condition were unaffected by the pandemic's circumstances.
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Affiliation(s)
- Paulina Malarkiewicz
- Department of Obstetrics and Gynecology, School of Medicine, Collegium Medicum of the University of Warmia and Mazury, al. Warszawska 30, 10-082 Olsztyn, Poland
| | - Urszula Nowacka
- Department of Obstetrics and Gynecology, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland
| | - Aleksandra Januszaniec
- Department of Obstetrics and Gynecology, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland
| | - Alicja Mankiewicz
- Department of Obstetrics and Gynecology, Olsztyn Specialist Hospital, Żołnierska 18; 10-561 Olsztyn, Poland
| | - Szymon Kozłowski
- Department of Obstetrics and Gynecology, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland
| | - Tadeusz Issat
- Department of Obstetrics and Gynecology, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland
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16
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Zorić L, Štritof PG, Čičak H, Zekan P, Pavasović MG, Blagaić V, Čoklo M, Šimundić AM, Dukić L. Verification of bile acid determination method and establishing reference intervals for biochemical and haematological parameters in third-trimester pregnant women. Clin Chem Lab Med 2024; 0:cclm-2023-1109. [PMID: 38557367 DOI: 10.1515/cclm-2023-1109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES The aims of this study were to verify the bile acids (BA) method and to establish reference intervals (RIs) for bile acids (BA) and biochemical and haematological parameters in Croatian pregnant women. METHODS BA spectrophotometric method verification was performed on Siemens Atellica Solution CH 930 automated analyser using Sentinel reagent. Stability, precision, trueness, linearity, and RIs, as well as lipemia interference were tested according to CLSI guidelines. BA, biochemical, and haematological parameters were measured in serum (BA, biochemical) and whole blood (haematological) samples of fasting healthy third-trimester pregnant women from Croatia (n=121). The establishment of the RIs was done a priori according to the CLSI EP28-A3C:2010 guideline. Selected reference individuals' data were analysed using parametric, non-parametric, and robust methods. RESULTS Stability study showed that BA are stable in serum samples for 2 days at 20 °C, 14 days at 4-8 °C, and 22 days at -20 °C. The precision study and adult RIs verification met the criteria. Linearity was verified for the concentration range of 3.5-172.1 μmol/L whereas the lipemia interference test showed a positive bias (%) in BA concentration. The determined reference limits generally exhibited better precision for haematological parameters, being lower than the upper recommended value 0.2, unlike biochemical parameters. Haematological parameters showed notable differences between pregnant and non-pregnant women, while many biochemical parameters' RIs remained similar. Only ALT and GGT showed lower non-comparable RI upper limits in the population pregnant women. CONCLUSIONS Spectrophotometric BA method showed satisfactory performance and all examined parameters were within the set criteria. Moreover, RIs for key biochemical and haematological parameters, including BAs, have been established for the first time in the population of Croatian pregnant women.
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Affiliation(s)
- Lara Zorić
- Department of Medical Laboratory Diagnostics, 119195 University Hospital "Sveti Duh" , Zagreb, Croatia
| | - Petra Glad Štritof
- Department of Obstetrics and Gynecology, 119195 University Hospital "Sveti Duh" , Zagreb, Croatia
| | - Helena Čičak
- Department of Medical Laboratory Diagnostics, 119195 University Hospital "Sveti Duh" , Zagreb, Croatia
| | - Paulo Zekan
- Department of Obstetrics and Gynecology, 119195 University Hospital "Sveti Duh" , Zagreb, Croatia
| | - Maria Gotić Pavasović
- Department of Obstetrics and Gynecology, 119195 University Hospital "Sveti Duh" , Zagreb, Croatia
| | - Vladimir Blagaić
- Department of Obstetrics and Gynecology, 119195 University Hospital "Sveti Duh" , Zagreb, Croatia
| | - Miran Čoklo
- Centre for Applied Bioanthropology, 162067 Institute for Anthropological Research , Zagreb, Croatia
| | - Ana-Maria Šimundić
- Department of Medical Laboratory Diagnostics, 119195 University Hospital "Sveti Duh" , Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, 119195 University of Zagreb , Zagreb, Croatia
| | - Lora Dukić
- Department of Medical Laboratory Diagnostics, 119195 University Hospital "Sveti Duh" , Zagreb, Croatia
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17
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Ye N, Shi X, Gao J, Dong R, Wang G, Wang J, Luo L, Zhang T. Exosomes from Intrahepatic Cholestasis of Pregnancy Induce Cell Apoptosis Through the miRNA-6891-5p/YWHAE Pathway. Dig Dis Sci 2024; 69:1253-1262. [PMID: 38361148 DOI: 10.1007/s10620-023-08265-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/21/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Intrahepatic cholestasis of pregnancy (ICP) is associated with adverse pregnancy outcomes; however, the underlying mechanisms are not fully understood. AIMS This study aimed to determine the role of exosomal miR-6891-5p in placental trophoblast dysfunction in ICP and identify new biomarkers for ICP diagnosis. METHODS Serum samples were collected from ICP patients and healthy pregnant women, and serum exosomes were extracted and identified. Fluorescent dye labeling of exosomes and cell-verified cell phagocytosis were performed. In vitro experiments were conducted by adding taurocholic acid to simulate the ICP environment. Cell proliferation and apoptosis levels were detected using flow cytometry and the cell counting kit-8 assay. Mimics were constructed to overexpress miR-6891-5p in cells, and the binding site between miR-6891-5p and YWHAE was verified using luciferase reporter genes. RESULTS miR-6891-5p expression was significantly decreased in serum exosomes of ICP patients. Co-culturing with exosomes derived from ICP patients' serum (ICP-Exos) decreased HTR-8/SVeno cell proliferation and increased apoptosis levels. miR-6891-5p upregulation in HTR-8/SVeno cells significantly increased cell viability and reduced cell apoptosis levels, as determined by the cell counting kit-8 assay and flow cytometry. A double luciferase assay confirmed that miR-6891-5p affected the expression of the downstream YWHAE protein. CONCLUSIONS This study indicates that serum exosomes from ICP patients can impact the apoptosis of placental trophoblast HTR-8/SVeno cells through the miR-6891-5P/YWHAE pathway and can serve as specific molecular markers for ICP diagnosis.
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Affiliation(s)
- Ningzhen Ye
- Wuxi Maternity and Child Health Care Hospital, Women's Hospital of Jiangnan University, Jiangnan University, Wuxi, 214002, China
| | - Xinrui Shi
- Wuxi School of Medicine, Jiangnan University, Wuxi, 214122, China
| | - Jianyi Gao
- Wuxi Maternity and Child Health Care Hospital, Women's Hospital of Jiangnan University, Jiangnan University, Wuxi, 214002, China
| | - Ruirui Dong
- Wuxi Maternity and Child Health Care Hospital, Women's Hospital of Jiangnan University, Jiangnan University, Wuxi, 214002, China
| | - Gaoying Wang
- Wuxi Maternity and Child Health Care Hospital, Women's Hospital of Jiangnan University, Jiangnan University, Wuxi, 214002, China
| | - Jing Wang
- Wuxi Maternity and Child Health Care Hospital, Women's Hospital of Jiangnan University, Jiangnan University, Wuxi, 214002, China
| | - Liang Luo
- Wuxi No.2 People's Hospital, Jiangnan University Medical Center, Jiangnan University, Wuxi, 214001, China
| | - Ting Zhang
- Wuxi Maternity and Child Health Care Hospital, Women's Hospital of Jiangnan University, Jiangnan University, Wuxi, 214002, China.
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18
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Fass L, Sibbald C, Bailey E, Zhang W, Lucey M. Severe Elevated Bile Acids in Early Pregnancy. ACG Case Rep J 2024; 11:e01317. [PMID: 38560018 PMCID: PMC10977523 DOI: 10.14309/crj.0000000000001317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Intrahepatic cholestasis of pregnancy (ICP) typically presents in the second half of pregnancy. Severe ICP is associated with increased risk of stillbirth. Little is known regarding elevated bile acids in the first trimester. We present a case of severely elevated bile acids in the first trimester, resistant to conservative management, in a patient with pre-existing cholestatic liver disease and aortic valve disease requiring anticoagulation. Therapeutic plasma exchange was used. In those with pre-existing cholestatic disease, early bile acid elevation is likely distinct from ICP, and conservative strategies may not be useful. In addition, therapeutic enoxaparin appears safe in therapeutic plasma exchange.
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Affiliation(s)
- Lucas Fass
- Department of Internal Medicine, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Carrie Sibbald
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Erin Bailey
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Wei Zhang
- Department of Molecular and Laboratory Pathology, University of Kansas Medical Center, Kansas City, KS
| | - Michael Lucey
- Department of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI
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19
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Sarker MR, Debolt CA, Canfield D, Ferrara L. History of Cholestasis is not Associated with Worsening Outcomes in Subsequent Pregnancy with Cholestasis. Am J Perinatol 2024. [PMID: 38423120 DOI: 10.1055/a-2278-9539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Intrahepatic cholestasis of pregnancy is associated with adverse pregnancy outcomes including intrauterine fetal demise, spontaneous preterm labor, and meconium-stained amniotic fluid. Studies have yet to determine if patients with a history of pregnancy complicated by cholestasis had an association with more severe adverse outcomes in a subsequent pregnancy complicated by cholestasis. STUDY DESIGN Retrospective cohort study of multiparous, singleton, nonanomalous live gestations complicated by cholestasis at Elmhurst Hospital Center from 2005 to 2019. We compared rates of adverse outcomes in multiparous pregnancies complicated by cholestasis with versus without prior cholestasis. Our primary outcome was rates of spontaneous preterm labor. Our secondary outcomes included rates of iatrogenic preterm birth, meconium-stained amniotic fluid, cesarean delivery for nonreassuring fetal heart tracing. Chi-square and multivariate regression tests were used to determine the strength of association. In all analyses, a p-value less than 0.05 and 95% confidence interval not crossing 1.00 indicated statistical significance. Mount Sinai Icahn School of Medicine Institutional Review Board approval was obtained for this project. RESULTS Of the 795 multiparous pregnancies complicated by cholestasis, 618 (77.7%) had no prior history of cholestasis and 177 (23.3%) had prior history of cholestasis. Multiparous pregnancies with history of cholestasis had higher rates of prior preterm birth, earlier gestational age at diagnosis and delivery, and were more likely to receive ursodeoxycholic acid therapy. Pregnancies with history of cholestasis were not associated with spontaneous preterm labor in subsequent pregnancies with cholestasis, but history of cholestasis was associated with iatrogenic preterm birth and neonatal intensive care unit (NICU) admission. After adjusting for confounders, the association with iatrogenic preterm birth and NICU admission were no longer statistically significant. There was no significant association between history of cholestasis and other adverse obstetric outcomes. CONCLUSION Findings suggests that history of prior cholestasis is not associated with worsening outcomes in subsequent pregnancies complicated by cholestasis. KEY POINTS · Prior cholestasis may not alter risk in subsequent pregnancies.. · Unclear relationship between cholestasis and hepatobiliary disease.. · Studies needed to develop cholestasis screening protocol..
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Affiliation(s)
- Minhazur R Sarker
- 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
| | - Chelsea A Debolt
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York
| | - Dana Canfield
- Department of Obstetrics, Gynecology and Reproductive Science, University of California San Diego, San Diego, California
| | - Lauren Ferrara
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York
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20
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Li H, Gao L, Yang X, Chen L. Development and validation of a risk prediction model for preterm birth in women with gestational diabetes mellitus. Clin Endocrinol (Oxf) 2024. [PMID: 38462989 DOI: 10.1111/cen.15044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVES This study aims to develop and validate a prediction model for preterm birth in women with gestational diabetes mellitus (GDM). DESIGN We conducted a retrospective study on women with GDM who gave birth at the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China, between November 2017 and July 2021. We divided 1879 patients into a development set (n = 1346) and a validation set (n = 533). The development set was used to construct the prediction model for preterm birth using the stepwise logistic regression model. A nomogram and a web calculator were established based on the model. Discrimination and calibration were assessed in both sets. PATIENTS AND MEASUREMENTS Patients were women with GDM. Data were collected from medical records. GDM was diagnosed with 75-g oral glucose tolerance test during 24-28 gestational weeks. Preterm birth was definied as gestational age at birth <37 weeks. RESULTS The incidence of preterm birth was 9.4%. The predictive model included age, assisted reproductive technology, hypertensive disorders of pregnancy, reproductive system inflammation, intrahepatic cholestasis of pregnancy, high-density lipoprotein, homocysteine, and fasting blood glucose of 75-g oral glucose tolerance test. The area under the receiver operating characteristic curve for the development and validation sets was 0.722 and 0.632, respectively. The model has been adequately calibrated using a calibration curve and the Hosmer-Lemeshow test, demonstrating a correlation between the predicted and observed risk. CONCLUSION This study presents a novel, validated risk model for preterm birth in pregnant women with GDM, providing an individualized risk estimation using clinical risk factors in the third trimester of pregnancy.
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Affiliation(s)
- Hanbing Li
- School of Nursing, University of South China, Hengyang, Hunan, China
| | - Lingling Gao
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Xiao Yang
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Lu Chen
- School of Nursing, Sun Yat-sen University, Guangzhou, China
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21
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Zhao C, Jia J, Wu H, Xu Q, Lyu X, Liu M, Hu X, Lei J, Deng Y, He Y, Wang Y, Peng Z, Zhang Y, Zhang H, Wang Q, Shen H, Zhang Y, Yan D, Yang Y, Ma X. Maternal Preconception Serum Alanine Aminotransferase Levels and Risk of Preterm Birth among Reproductive-Aged Women - China, 2013-2017. China CDC Wkly 2024; 6:181-188. [PMID: 38523811 PMCID: PMC10960516 DOI: 10.46234/ccdcw2024.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/24/2024] [Indexed: 03/26/2024] Open
Abstract
What is already known about this topic? The significance of maternal liver health concerning preterm birth (PTB) is well recognized; however, there is a gap in understanding the precise influence of preconception serum alanine aminotransferase (ALT) levels on the risk of PTB. What is added by this report? In this retrospective cohort study, a J-shaped relationship between preconception serum ALT levels and risk of PTB was observed, indicating that both significantly elevated and decreased ALT levels may contribute to the risk. What are the implications for public health practice? Maintaining optimal preconception serum ALT levels may reduce the risk of PTB, thereby informing specific preventive measures for women of reproductive age.
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Affiliation(s)
- Chuanyu Zhao
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Jiajing Jia
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hanbin Wu
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
| | - Qin Xu
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
| | - Xinyi Lyu
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Meiya Liu
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
| | - Xuan Hu
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
| | - Jueming Lei
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
| | - Yuzhi Deng
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
| | - Yuan He
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Yuanyuan Wang
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Zuoqi Peng
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
| | - Ya Zhang
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
| | - Hongguang Zhang
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
| | - Qiaomei Wang
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
| | - Haiping Shen
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
| | - Yiping Zhang
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
| | - Donghai Yan
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
| | - Ying Yang
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Xu Ma
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
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22
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Li X, Cai QY, Luo X, Wang YH, Shao LZ, Luo SJ, Wang L, Wang YX, Lan X, Liu TH. Gestational diabetes mellitus aggravates adverse perinatal outcomes in women with intrahepatic cholestasis of pregnancy. Diabetol Metab Syndr 2024; 16:57. [PMID: 38429774 PMCID: PMC10908036 DOI: 10.1186/s13098-024-01294-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 02/17/2024] [Indexed: 03/03/2024] Open
Abstract
PURPOSE To evaluate the effect of intrahepatic cholestasis of pregnancy (ICP) with gestational diabetes mellitus (GDM) on perinatal outcomes and establish a prediction model of adverse perinatal outcomes in women with ICP. METHODS This multicenter retrospective cohort study included the clinical data of 2,178 pregnant women with ICP, including 1,788 women with ICP and 390 co-occurrence ICP and GDM. The data of all subjects were collected from hospital electronic medical records. Univariate and multivariate logistic regression analysis were used to compare the incidence of perinatal outcomes between ICP with GDM group and ICP alone group. RESULTS Baseline characteristics of the population revealed that maternal age (p < 0.001), pregestational weight (p = 0.01), pre-pregnancy BMI (p < 0.001), gestational weight gain (p < 0.001), assisted reproductive technology (ART) (p < 0.001), and total bile acid concentration (p = 0.024) may be risk factors for ICP with GDM. Furthermore, ICP with GDM demonstrated a higher association with both polyhydramnios (OR 2.66) and preterm labor (OR 1.67) compared to ICP alone. Further subgroup analysis based on the severity of ICP showed that elevated total bile acid concentrations were closely associated with an increased risk of preterm labour, meconium-stained amniotic fluid, and low birth weight in both ICP alone and ICP with GDM groups. ICP with GDM further worsened these outcomes, especially in women with severe ICP. The nomogram prediction model effectively predicted the occurrence of preterm labour in the ICP population. CONCLUSIONS ICP with GDM may result in more adverse pregnancy outcomes, which are associated with bile acid concentrations.
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Affiliation(s)
- Xia Li
- Department of Bioinformatics, School of Basic Medical Sciences , Chongqing Medical University, No.1 Yixueyuan Rd, Yuzhong District, 400016, Chongqing, China
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, 400016, Chongqing, China
| | - Qin-Yu Cai
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, 400016, Chongqing, China
- Department of Obstetrics, Women and Children's Hospital of Chongqing Medical University, 401147, Chongqing, China
| | - Xin Luo
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, 400016, Chongqing, China
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, China
| | - Yong-Heng Wang
- Department of Bioinformatics, School of Basic Medical Sciences , Chongqing Medical University, No.1 Yixueyuan Rd, Yuzhong District, 400016, Chongqing, China
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, 400016, Chongqing, China
| | - Li-Zhen Shao
- Department of Bioinformatics, School of Basic Medical Sciences , Chongqing Medical University, No.1 Yixueyuan Rd, Yuzhong District, 400016, Chongqing, China
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, 400016, Chongqing, China
| | - Shu-Juan Luo
- Department of Obstetrics, Women and Children's Hospital of Chongqing Medical University, 401147, Chongqing, China
| | - Lan Wang
- Department of Obstetrics, Women and Children's Hospital of Chongqing Medical University, 401147, Chongqing, China
| | - Ying-Xiong Wang
- Department of Bioinformatics, School of Basic Medical Sciences , Chongqing Medical University, No.1 Yixueyuan Rd, Yuzhong District, 400016, Chongqing, China
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, 400016, Chongqing, China
| | - Xia Lan
- Department of Obstetrics, Women and Children's Hospital of Chongqing Medical University, 401147, Chongqing, China.
| | - Tai-Hang Liu
- Department of Bioinformatics, School of Basic Medical Sciences , Chongqing Medical University, No.1 Yixueyuan Rd, Yuzhong District, 400016, Chongqing, China.
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, 400016, Chongqing, China.
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23
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Zhang Y, Liu Y, Huo W, He L, Li B, Wang H, Meng F, Duan C, Zhou B, Wu J, Chen R, Xing J, Wan Y. The Role of miRNA and Long Noncoding RNA in Cholestatic Liver Diseases. THE AMERICAN JOURNAL OF PATHOLOGY 2024:S0002-9440(24)00075-0. [PMID: 38417698 DOI: 10.1016/j.ajpath.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/05/2024] [Accepted: 02/16/2024] [Indexed: 03/01/2024]
Abstract
Cholestatic liver diseases encompass a range of organic damages, metabolic disorders, and dysfunctions within the hepatobiliary system, arising from various pathogenic causes. These factors contribute to disruptions in bile production, secretion, and excretion. Cholestatic liver diseases can be classified into intrahepatic and extrahepatic cholestasis, according to the location of occurrence. The etiology of cholestatic liver diseases is complex, and includes drugs, poisons, viruses, parasites, bacteria, autoimmune responses, tumors, and genetic metabolism. The pathogenesis of cholelstatic liver disease is not completely clarified; also, there is still a lack of effective therapy methods. It is urgent to clarify its mechanism to find more effective therapeutic targets and drugs. Increasing evidence demonstrates that miRNA and long noncoding RNA are involved in the progression of cholestatic liver diseases. This review provides a comprehensive summary of the research progress on the roles of miRNA and long noncoding RNA in cholestatic liver diseases. The aim is to enhance the understanding of their potential diagnostic, therapeutic, and prognostic value for patients with cholestasis.
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Affiliation(s)
- Yudian Zhang
- School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
| | - Ying Liu
- School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
| | - Wen Huo
- Functional Experiment Center, College of Basic and Legal Medicine, North Sichuan Medical College, Nanchong, China
| | - Longfei He
- School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
| | - Bowen Li
- School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
| | - Hui Wang
- School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
| | - Fanyin Meng
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Richard L. Roudebush VA Medical Center, Indianapolis, Indiana
| | - Chenggang Duan
- School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
| | - Bingru Zhou
- School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
| | - Jinbo Wu
- Department of Otolaryngology-Head and Neck Surgery, Luzhou Maternal and Child Health Hospital (Luzhou Second People's Hospital), Luzhou, China
| | - Rong Chen
- School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
| | - Juan Xing
- School of Basic Medical Sciences, Southwest Medical University, Luzhou, China.
| | - Ying Wan
- School of Basic Medical Sciences, Southwest Medical University, Luzhou, China.
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24
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Porrello G, Cannella R, Bernuau J, Agman A, Brancatelli G, Dioguardi Burgio M, Vilgrain V. Liver imaging and pregnancy: what to expect when your patient is expecting. Insights Imaging 2024; 15:66. [PMID: 38411871 PMCID: PMC10899155 DOI: 10.1186/s13244-024-01622-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/07/2024] [Indexed: 02/28/2024] Open
Abstract
Liver diseases in pregnancy can be specific to gestation or only coincidental. In the latter case, the diagnosis can be difficult. Rapid diagnosis of maternal-fetal emergencies and situations requiring specialized interventions are crucial to preserve the maternal liver and guarantee materno-fetal survival. While detailed questioning of the patient and a clinical examination are highly important, imaging is often essential to reach a diagnosis of these liver diseases and lesions. Three groups of liver diseases may be observed during pregnancy: (1) diseases related to pregnancy: intrahepatic cholestasis of pregnancy, pre-eclampsia, eclampsia, hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, and acute fatty liver of pregnancy; (2) liver diseases that are more frequent during or exacerbated by pregnancy: acute herpes simplex hepatitis, Budd-Chiari syndrome, hemorrhagic hereditary telangiectasia, hepatocellular adenoma, portal vein thrombosis, and cholelithiasis; (3) coincidental conditions, including acute hepatitis, incidental focal liver lesions, metabolic dysfunction-associated steatotic liver disease, cirrhosis, hepatocellular carcinoma, liver abscesses and parasitosis, and liver transplantation. Specific knowledge of the main imaging findings is required to reach an early diagnosis, for adequate follow-up, and to avoid adverse consequences in both the mother and the fetus.Critical relevance statement Pregnancy-related liver diseases are the most important cause of liver dysfunction in pregnant patients and, in pregnancy, even common liver conditions can have an unexpected turn. Fear of radiations should never delay necessary imaging studies in pregnancy.Key points• Pregnancy-related liver diseases are the most frequent cause of liver dysfunction during gestation.• Fear of radiation should never delay necessary imaging studies.• Liver imaging is important to assess liver emergencies and for the diagnosis and follow-up of any other liver diseases.• Common liver conditions and lesions may take an unexpected turn during pregnancy.• Pregnancy-specific diseases such as pre-eclampsia and HELLP syndrome must be rapidly identified. However, imaging should never delay delivery when it is considered to be urgent for maternal-fetal survival.
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Affiliation(s)
- Giorgia Porrello
- Service de Radiologie, AP-HP Nord, Hôpital Beaujon, Paris, Clichy, France.
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University Hospital "Paolo Giaccone", Palermo, Italy.
| | - Roberto Cannella
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University Hospital "Paolo Giaccone", Palermo, Italy
| | - Jacques Bernuau
- AP-HP Nord, Hôpital Beaujon, Service d'Hépatologie, Paris, Clichy, France
| | - Antoine Agman
- Service de Gynécologie obstétrique maternité, AP-HP Nord, Hôpital Beaujon, Paris, Clichy, France
| | - Giuseppe Brancatelli
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University Hospital "Paolo Giaccone", Palermo, Italy
| | - Marco Dioguardi Burgio
- Service de Radiologie, AP-HP Nord, Hôpital Beaujon, Paris, Clichy, France
- Université Paris Cité, Inserm, Centre de recherche sur l'inflammation, F-75018, Paris, France
| | - Valérie Vilgrain
- Service de Radiologie, AP-HP Nord, Hôpital Beaujon, Paris, Clichy, France
- Université Paris Cité, Inserm, Centre de recherche sur l'inflammation, F-75018, Paris, France
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25
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Liu W, Li Z, Ze X, Deng C, Xu S, Ye F. Multispecies probiotics complex improves bile acids and gut microbiota metabolism status in an in vitro fermentation model. Front Microbiol 2024; 15:1314528. [PMID: 38444809 PMCID: PMC10913090 DOI: 10.3389/fmicb.2024.1314528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/31/2024] [Indexed: 03/07/2024] Open
Abstract
The consumption of probiotics has been extensively employed for the management or prevention of gastrointestinal disorders by modifying the gut microbiota and changing metabolites. Nevertheless, the probiotic-mediated regulation of host metabolism through the metabolism of bile acids (BAs) remains inadequately comprehended. The gut-liver axis has received more attention in recent years due to its association with BA metabolism. The objective of this research was to examine the changes in BAs and gut microbiota using an in vitro fermentation model. The metabolism and regulation of gut microbiota by commercial probiotics complex containing various species such as Lactobacillus, Bifidobacterium, and Streptococcus were investigated. The findings indicated that the probiotic strains had produced diverse metabolic profiles of BAs. The probiotics mixture demonstrated the greatest capacity for Bile salt hydrolase (BSH) deconjugation and 7α-dehydroxylation, leading to a significant elevation in the concentrations of Chenodeoxycholic acid, Deoxycholic acidcholic acid, and hyocholic acid in humans. In addition, the probiotic mixtures have the potential to regulate the microbiome of the human intestines, resulting in a reduction of isobutyric acid, isovaleric acid, hydrogen sulfide, and ammonia. The probiotics complex intervention group showed a significant increase in the quantities of Lactobacillus and Bifidobacterium strains, in comparison to the control group. Hence, the use of probiotics complex to alter gut bacteria and enhance the conversion of BAs could be a promising approach to mitigate metabolic disorders in individuals.
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Affiliation(s)
- Wei Liu
- Institute of Plant Protection and Microbiology, Zhejiang Academy of Agricultural Sciences, Hangzhou, China
| | - Zhongxia Li
- BYHEALTH Institute of Nutrition and Health, Guangzhou, China
| | - Xiaolei Ze
- BYHEALTH Institute of Nutrition and Health, Guangzhou, China
| | - Chaoming Deng
- BYHEALTH Institute of Nutrition and Health, Guangzhou, China
| | - Shunfu Xu
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Feng Ye
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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26
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Peker A, Tanaçan A, İpek G, Ağaoğlu Z, Şahin D. Role of aspartate aminotransferase to platelet ratio in the prediction and prognosis of intrahepatic cholestasis of pregnancy: A case-control study from a tertiary center. Int J Gynaecol Obstet 2024; 164:656-661. [PMID: 37493015 DOI: 10.1002/ijgo.15016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE To evaluate the aspartate aminotransferase to platelet ratio (APRI) score as a predictive and prognostic test in intrahepatic cholestasis of pregnancy (ICP). METHODS This study was conducted in 198 patients diagnosed with ICP and 204 healthy pregnant women who presented to a tertiary center between 2019 and 2022. APRI scores; laboratory findings in the first, second, and third trimesters; and perinatal outcomes were compared between the two groups. The ICP group was evaluated for correlation between APRI scores and composite adverse outcomes. Two different receiver operating characteristic analyses were performed to determine optimal cutoff values of predictive APRI score of ICP and composite adverse outcomes in patients with ICP. RESULTS Aspartate aminotransferase values and APRI scores were significantly higher in the ICP group in all trimesters (P < 0.001). The optimal cutoff values of APRI scores to predict ICP for the first, second, and third trimesters were 0.101 (79.7% sensitivity, 79.6% specificity), 0.103 (78.4% sensitivity, 76.3% specificity), and 0.098 (72.5% sensitivity, 72% specificity), respectively. APRI scores were statistically higher in patients with ICP with composite adverse outcomes in all trimesters (P values of 0.03, 0.04, and 0.01, respectively). CONCLUSION APRI score was found to be a valuable predictor of ICP and its adverse outcomes during the entire pregnancy.
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Affiliation(s)
- Ayça Peker
- Division of Perinatology, Department of Obstetrics and Gynecolgy, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanaçan
- Division of Perinatology, Department of Obstetrics and Gynecolgy, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Göksun İpek
- Division of Perinatology, Department of Obstetrics and Gynecolgy, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Zahid Ağaoğlu
- Division of Perinatology, Department of Obstetrics and Gynecolgy, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Şahin
- Division of Perinatology, Department of Obstetrics and Gynecolgy, Turkish Ministry of Health Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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27
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Tang M, Xiong L, Cai J, Fu J, Liu H, Ye Y, Yang L, Xing S, Yang X. Intrahepatic cholestasis of pregnancy: insights into pathogenesis and advances in omics studies. Hepatol Int 2024; 18:50-62. [PMID: 37957532 DOI: 10.1007/s12072-023-10604-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/28/2023] [Indexed: 11/15/2023]
Abstract
Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy-specific liver disease. It is characterized by pruritus, abnormal liver function and elevated total bile acid (TBA) levels, increasing the risk of maternal and fetal adverse outcomes. Its etiology remains poorly elucidated. Over the years, various omics techniques, including metabolomics, microbiome, genomics, etc., have emerged with the advancement of bioinformatics, providing a new direction for exploring the pathogenesis, diagnosis and treatment of ICP. In this review, we first summarize the role of bile acids and related components in the pathogenesis of ICP and then further illustrate the results of omics studies.
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Affiliation(s)
- Mi Tang
- GCP Institution, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Liling Xiong
- Obstetrics Department, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Jianghui Cai
- Department of Pharmacy, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jinzhu Fu
- Obstetrics Department, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Hong Liu
- Operating Theater, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Ying Ye
- Operating Theater, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Li Yang
- Obstetrics Department, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - ShaSha Xing
- GCP Institution, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China.
| | - Xiao Yang
- Obstetrics Department, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China.
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Obut M, Kından A, Ibanoğlu MC, Çayönü Kahraman N, Arat Ö, Keleş A, Topkara S, Tokgöz Çakır B, Bucak M, İskender CT. Liver damage parameters and peripheral blood parameters for prediction and diagnosis of intrahepatic cholestasis in pregnancy. J Obstet Gynaecol Res 2024; 50:196-204. [PMID: 37994385 DOI: 10.1111/jog.15837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE Intrahepatic cholestasis of pregnancy (ICP) manifests in late pregnancy. Elevated serum bile acid is a diagnostic criterion: however, its measurement is troublesome. Prediction of ICP by blood markers is not established. Serum bile acid level is associated with liver damage and inflammation. We hypothesized that the following markers could predict the occurrence of ICP and have diagnostic value for it: Liver damage-indicating scores (albumin-bilirubin [ALBI], Model for End-Stage Liver Disease [MELD], aspartate aminotransferase-to-platelet ratio [APRI]) and inflammatory markers (platelet-to-lymphocyte ratio [PLR] and neutrophil-to-lymphocyte ratio [NLR]). METHODS Eighty ICP patients and 200 controls were studied. The values of MELD, APRI, ALBI, PLR, and NLR were measured in the 1st trimester and at the time of diagnosis. RESULTS Patients with ICP had significantly higher ALBI, MELD, and APRI scores both in the first trimester and at diagnosis. Multivariate logistic regression (MLR) showed that age, ALBI, MELD, and APRI scores were statistically significant (p < 0.05). By receiver operating characteristic (ROC) analysis, the sensitivity of MELD, ALBI, APRI, and NLR in the first trimester was 62%, 73%, 58%, and 29%, respectively, and MELD, ALBI, APRI, and PLR at diagnosis was 28%, 38%, 57%, and 8%, respectively, with a fixed false-positive rate of 10%. CONCLUSION This study has demonstrated the usability of the MELD, ALBI, and APRI scores in predicting and diagnosing ICP. They are easy to obtain and might be used in routine practice.
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Affiliation(s)
- Mehmet Obut
- Department of Perinatology, Health Sciences University, Etlik Zübeyde Hanım Woman's Health Training and Research Hospital, Ankara, Turkey
| | - Aykut Kından
- Department of Gynecology and Obstetrics, Health Sciences University, Etlik Zübeyde Hanım Woman's Health Training and Research Hospital, Ankara, Turkey
| | - Müjde Can Ibanoğlu
- Department of Gynecology and Obstetrics, Health Sciences University, Etlik Zübeyde Hanım Woman's Health Training and Research Hospital, Ankara, Turkey
| | - Neval Çayönü Kahraman
- Department of Perinatology, Health Sciences University, Etlik Zübeyde Hanım Woman's Health Training and Research Hospital, Ankara, Turkey
| | - Özgür Arat
- Department of Perinatology, Health Sciences University, Etlik Zübeyde Hanım Woman's Health Training and Research Hospital, Ankara, Turkey
| | - Ayşe Keleş
- Department of Perinatology, Health Sciences University, Etlik Zübeyde Hanım Woman's Health Training and Research Hospital, Ankara, Turkey
| | - Serap Topkara
- Department of Gynecology and Obstetrics, Ministry Of Health, Etlik City Hospital, Ankara, Turkey
| | - Betül Tokgöz Çakır
- Department of Perinatology, Health Sciences University, Etlik Zübeyde Hanım Woman's Health Training and Research Hospital, Ankara, Turkey
| | - Mevlüt Bucak
- Department of Perinatology, Health Sciences University, Etlik Zübeyde Hanım Woman's Health Training and Research Hospital, Ankara, Turkey
| | - Can Tekin İskender
- Department of Perinatology, Health Sciences University, Etlik Zübeyde Hanım Woman's Health Training and Research Hospital, Ankara, Turkey
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Obiegbusi CN, Dong XJ, Obiegbusi SC, Jin X, Okoene IK. Predictors of Adverse Fetal Outcomes in Intrahepatic Cholestasis of Pregnancy (ICP): a Narrative Review. Reprod Sci 2024; 31:341-351. [PMID: 37626275 DOI: 10.1007/s43032-023-01329-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023]
Abstract
Intrahepatic cholestasis of pregnancy (ICP) is a hepatic disorder in pregnancy linked with adverse fetal outcomes, which primarily manifests in the late second and third trimesters of pregnancy. This review aims to recapitulate the existing evidence on factors that can predict detrimental perinatal outcomes in pregnant women diagnosed with intrahepatic cholestasis of pregnancy. We searched PubMed, Web of Science, Cochrane Library, Scopus, Medline, and Embase databases and selected studies related to predictors of fetal outcome in intrahepatic cholestasis of pregnancy. Studies of the articles showed that predictors of an adverse fetal outcome include in vitro fertilization (IVF) pregnancy, multifetal pregnancy, biochemical markers, gestational age of ICP onset, presence of comorbidities (preeclampsia and gestational diabetes mellitus), maternal history of ICP, and hepatobiliary disease.Intrahepatic cholestasis of pregnancy (ICP) complicates the pregnancy. Hence, early assessment of low-risk and high-risk groups will help to administer definite management protocols and strategies to prevent adverse neonatal outcomes. Further research should concentrate on the number of conditions/factors and the predictive power of different factors to determine the most reliable predictors and biomarkers that can predict adverse fetal outcomes and improve the assessment of risk in pregnancy complicated with ICP.
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Affiliation(s)
- Chidera Nneji Obiegbusi
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao Jing Dong
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Samuel Chigbo Obiegbusi
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao Jin
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Sanchon-Sanchez P, Herraez E, Macias RIR, Estiu MC, Fortes P, Monte MJ, Marin JJG, Romero MR. Relationship between cholestasis and altered progesterone metabolism in the placenta-maternal liver tandem. Biochim Biophys Acta Mol Basis Dis 2024; 1870:166926. [PMID: 37956602 DOI: 10.1016/j.bbadis.2023.166926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND In intrahepatic cholestasis of pregnancy (ICP), there are elevated maternal serum levels of total bile acids, progesterone, and some sulfated metabolites, such as allopregnanolone sulfate, which inhibits canalicular function. AIM To investigate the relationship between cholestasis and the expression of crucial enzymes involved in progesterone metabolism in the liver and placenta. METHODS Obstructive cholestasis was induced by bile duct ligation (BDL). RT-qPCR (mRNA) and western blot (protein) were used to determine expression levels. Srd5a1 and Akr1c2 enzymatic activities were assayed by substrate disappearance (progesterone and 5α-dihydroprogesterone, respectively), measured by HPLC-MS/MS. RESULTS BDL induced decreased Srd5a1 and Akr1c2 expression and activity in rat liver, whereas both enzymes were up-regulated in rat placenta. Regarding sulfotransferases, Sult2b1 was also moderately up-regulated in the liver. In placenta from ICP patients, SRD5A1 and AKR1C2 expression was elevated, whereas both genes were down-regulated in liver biopsies collected from patients with several liver diseases accompanied by cholestasis. SRD5A1 and AKR1C2 expression was not affected by incubating human hepatoma HepG2 cells with FXR agonists (chenodeoxycholic acid and GW4064). Knocking-out Fxr in mice did not reduce Srd5a1 and Akr1c14 expression, which was similarly down-regulated by BDL. CONCLUSION SRD5A1 and AKR1C2 expression was markedly altered by cholestasis. This was enhanced in the placenta but decreased in the liver, which is not mediated by FXR. These results suggest that the excess of progesterone metabolites in the serum of ICP patients can involve both enhanced placental production and decreased hepatic clearance. The latter may also occur in other cholestatic conditions.
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Affiliation(s)
- Paula Sanchon-Sanchez
- Experimental Hepatology and Drug Targeting (HEVEPHARM), IBSAL, University of Salamanca, Salamanca, Spain; National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd), Madrid, Spain
| | - Elisa Herraez
- Experimental Hepatology and Drug Targeting (HEVEPHARM), IBSAL, University of Salamanca, Salamanca, Spain; National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd), Madrid, Spain
| | - Rocio I R Macias
- Experimental Hepatology and Drug Targeting (HEVEPHARM), IBSAL, University of Salamanca, Salamanca, Spain; National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd), Madrid, Spain
| | - Maria C Estiu
- Ramon Sarda Mother's and Children's Hospital, Buenos Aires, Argentina
| | - Puri Fortes
- Foundation for Applied Medical Research (FIMA), School of Medicine, University of Navarra, Pamplona, Spain; National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd), Madrid, Spain
| | - Maria J Monte
- Experimental Hepatology and Drug Targeting (HEVEPHARM), IBSAL, University of Salamanca, Salamanca, Spain; National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd), Madrid, Spain
| | - Jose J G Marin
- Experimental Hepatology and Drug Targeting (HEVEPHARM), IBSAL, University of Salamanca, Salamanca, Spain; National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd), Madrid, Spain.
| | - Marta R Romero
- Experimental Hepatology and Drug Targeting (HEVEPHARM), IBSAL, University of Salamanca, Salamanca, Spain; National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd), Madrid, Spain
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Huang S, Liu S, Huang M, He JR, Wang C, Wang T, Feng X, Kuang Y, Lu J, Gu Y, Xia X, Lin S, Zhou W, Fu Q, Xia H, Qiu X. The Born in Guangzhou Cohort Study enables generational genetic discoveries. Nature 2024; 626:565-573. [PMID: 38297123 DOI: 10.1038/s41586-023-06988-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 12/15/2023] [Indexed: 02/02/2024]
Abstract
Genomic research that targets large-scale, prospective birth cohorts constitutes an essential strategy for understanding the influence of genetics and environment on human health1. Nonetheless, such studies remain scarce, particularly in Asia. Here we present the phase I genome study of the Born in Guangzhou Cohort Study2 (BIGCS), which encompasses the sequencing and analysis of 4,053 Chinese individuals, primarily composed of trios or mother-infant duos residing in South China. Our analysis reveals novel genetic variants, a high-quality reference panel, and fine-scale local genetic structure within BIGCS. Notably, we identify previously unreported East Asian-specific genetic associations with maternal total bile acid, gestational weight gain and infant cord blood traits. Additionally, we observe prevalent age-specific genetic effects on lipid levels in mothers and infants. In an exploratory intergenerational Mendelian randomization analysis, we estimate the maternal putatively causal and fetal genetic effects of seven adult phenotypes on seven fetal growth-related measurements. These findings illuminate the genetic links between maternal and early-life traits in an East Asian population and lay the groundwork for future research into the intricate interplay of genetics, intrauterine exposures and early-life experiences in shaping long-term health.
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Affiliation(s)
- Shujia Huang
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Siyang Liu
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, China
| | - Mingxi Huang
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jian-Rong He
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Provincial Clinical Research Center for Child Health, Guangzhou, China
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Chengrui Wang
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Tianyi Wang
- Key Laboratory of Vertebrate Evolution and Human Origins, Institute of Vertebrate Paleontology and Paleoanthropology, Chinese Academy of Sciences, Beijing, China
- University of the Chinese Academy of Sciences, Beijing, China
| | - Xiaotian Feng
- Key Laboratory of Vertebrate Evolution and Human Origins, Institute of Vertebrate Paleontology and Paleoanthropology, Chinese Academy of Sciences, Beijing, China
- University of the Chinese Academy of Sciences, Beijing, China
| | - Yashu Kuang
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Jinhua Lu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Yuqin Gu
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, China
| | - Xiaoyan Xia
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Department of Women's Health, Provincial Key Clinical Specialty of Woman and Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Shanshan Lin
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Department of Women's Health, Provincial Key Clinical Specialty of Woman and Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wenhao Zhou
- Division of Neonatology and Center for Newborn Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Qiaomei Fu
- Key Laboratory of Vertebrate Evolution and Human Origins, Institute of Vertebrate Paleontology and Paleoanthropology, Chinese Academy of Sciences, Beijing, China
- University of the Chinese Academy of Sciences, Beijing, China
| | - Huimin Xia
- Provincial Clinical Research Center for Child Health, Guangzhou, China.
- Provincial Key Laboratory of Research in Structure Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
| | - Xiu Qiu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
- Provincial Clinical Research Center for Child Health, Guangzhou, China.
- Department of Women's Health, Provincial Key Clinical Specialty of Woman and Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
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Tai M, Chen L, He Y, Wang F, Tian Z. Ultrasonographic evaluation of the gallbladder motor function in the diagnosis and prognosis of intrahepatic cholestasis of pregnancy. BMC Pregnancy Childbirth 2024; 24:17. [PMID: 38166795 PMCID: PMC10759328 DOI: 10.1186/s12884-023-06209-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Intrahepatic cholestasis of pregnancy (ICP) is characterized by skin pruritus, elevated liver enzymes, and increased serum total bile acids. Several previous studies have revealed that the fasting and ejection volumes of the gallbladder in cholestasis of pregnancy are greater than those in normal pregnancy. The goal of this study was to explore the gallbladder volume and evaluate the diagnostic and prognostic value of ultrasound in ICP. METHODS We prospectively recruited a cohort of 60 ICP patients at the First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, China from January 2020 to December 2021 and compared their data with those from healthy pregnant women (n = 60). The gallbladder volume was evaluated by real-time ultrasound examination after overnight fasting and at 30, 60, 120, and 180 min after a liquid test meal of 200 mL, and the ejection fraction was calculated. Continuous data between two groups were compared by Student's t test. Differences were considered significant for p < 0.05. The diagnostic and prognostic value of the volume and ejection function of the gallbladder was analyzed by the receiver operating characteristic (ROC) curve. RESULTS The ICP group had significantly higher gallbladder basal volume (43.49 ± 1.34 cm3 vs. 26.66 ± 0.83 cm3, p < 0.01) and higher ejection fraction compared with the healthy group. The ejection fraction higher than 54.55% at 120 min might predict ICP diagnosis with 96.67% sensitivity and 88.33% specificity, and an AUC of 0.9739 (95% CI 0.9521-0.9956), while the gallbladder volume higher than 12.52 cm3 at 60 min might predict ICP severity with 59.18% sensitivity and 72.73% specificity, and an AUC of 0.7319 (95% CI 0.5787-0.8852). CONCLUSION Our results indicate abnormal volume and ejection function of the gallbladder in patients with ICP. The ejection fraction at 120 min can assist in the diagnosis if ICP exists, and the gallbladder volume at 60 min may assess the degree of severity of ICP.
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Affiliation(s)
- Minghui Tai
- Department of Ultrasound, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta Road (w), Xi'an City, Shaanxi province, 710061, China
| | - Long Chen
- Department of Ultrasound Medicine, Baoji High-Tech Hospital, Baoji, Shaanxi province, China
| | - Yajuan He
- Department of Ultrasound, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta Road (w), Xi'an City, Shaanxi province, 710061, China
| | - Fei Wang
- Department of Ultrasound, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta Road (w), Xi'an City, Shaanxi province, 710061, China.
| | - Zhen Tian
- Department of Ultrasound, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta Road (w), Xi'an City, Shaanxi province, 710061, China.
- Department of Infectious Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an City, Shaanxi province, China.
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Cai QY, Li ZH, Deng BN, Luo X, Lan X, Chen Y, Liang LF, Liu CY, Liu TH, Wang YX, Wang L. A nomogram for predicting the risk of preeclampsia in women with intrahepatic cholestasis of pregnancy based on prenatal monitoring time: a multicenter retrospective cohort study. J Hypertens 2024; 42:143-152. [PMID: 37737865 PMCID: PMC10712991 DOI: 10.1097/hjh.0000000000003577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/03/2023] [Accepted: 08/25/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND AND AIMS Intrahepatic cholestasis of pregnancy (ICP) is a special liver disease during pregnancy, characterized by abnormal bile acid metabolism. However, there is no consensus on how to group women with ICP based on the time of diagnosis worldwide. This study aimed to adopt a new grouping model of women with ICP, and the time from diagnosis to delivery was defined as the monitoring period. METHODS This retrospective real-world data study was conducted across multiple centers and included 3172 women with ICP. The study first evaluated the significant difference in medication and nonmedication during different monitoring times. The least absolute shrinkage and selection operator (LASSO) model was then used to screen nine risk factors based on the predictors. The model's discrimination, clinical usefulness, and calibration were assessed using the area under the receiver operating characteristic (ROC) curve, decision curve, and calibration analysis. RESULTS The incidence of preeclampsia risk in ICP patients without drug intervention increased with the extension of the monitoring period. However, the risk of preeclampsia decreased in ICP patients treated with ursodeoxycholic acid. A predictive nomogram and risk score model was developed based on nine risk factors. The area under the ROC curve of the nomogram was 0.765 [95% confidence interval (CI): 0.724-0.807] and 0.812 (95% CI: 0.736-0.889) for the validation cohort. CONCLUSIONS This study found that a longer ICP monitoring period could lead to adverse pregnancy outcomes in the absence of drug intervention, especially preeclampsia. A predictive nomogram and risk score model was developed to better manage ICP patients, maintain pregnancy to term delivery, and minimize the risk of severe adverse maternal and fetal outcomes.
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Affiliation(s)
- Qin-Yu Cai
- Department of Obstetrics, Women and Children's Hospital of Chongqing Medical University
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, Yuzhong District of Chongqing
| | - Zhuo-Hang Li
- Department of Obstetrics, Women and Children's Hospital of Chongqing Medical University
- Medical Laboratory Department, Traditional Chinese Medicine Hospital of Yaan, Sichuan
| | - Bei-Ning Deng
- Department of Obstetrics, Women and Children's Hospital of Chongqing Medical University
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, Yuzhong District of Chongqing
| | - Xin Luo
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, Yuzhong District of Chongqing
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, China
| | - Xia Lan
- Department of Obstetrics, Women and Children's Hospital of Chongqing Medical University
| | - Ya Chen
- Department of Obstetrics, Women and Children's Hospital of Chongqing Medical University
| | - Li-Fang Liang
- Department of Obstetrics, Women and Children's Hospital of Chongqing Medical University
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, Yuzhong District of Chongqing
| | - Chen-Yang Liu
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, Yuzhong District of Chongqing
| | - Tai-Hang Liu
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, Yuzhong District of Chongqing
| | - Ying-Xiong Wang
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, Yuzhong District of Chongqing
| | - Lan Wang
- Department of Obstetrics, Women and Children's Hospital of Chongqing Medical University
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Xu T, Zhan Y, Chen D, Deng X, Mao C, Xu J, Wang X, Guo B, Wang X. Risk-stratified management strategies for intrahepatic cholestasis of pregnancy: A tertiary center population review over nearly 5 years. Int J Gynaecol Obstet 2024; 164:219-226. [PMID: 37470272 DOI: 10.1002/ijgo.14987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 03/16/2023] [Accepted: 06/19/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE Intrahepatic cholestasis of pregnancy (ICP) is associated with an increased risk of adverse perinatal outcomes, resulting in a higher risk of perinatal morbidity and mortality. METHODS The authors conducted a retrospective study of 2385 singletons with ICP who underwent risk-stratified management strategies. To explore the risks of perinatal outcomes of ICP, subgroup analyses were performed using different total bile acid (TBA) levels. RESULTS In this study, there was only one stillbirth and one neonatal death. Among the study cohort, 2299 patients had ICP with a TBA level ≥10 μmol/L and 86 had ICP with a TBA level <10 μmol/L. The 2299 patients with ICP (TBA level ≥ 10 μmol/L) were divided into three groups: mild ICP (n = 1803), severe ICP (n = 400), and extremely severe ICP (n = 96). Increased TBA concentration was associated with an increased incidence of preterm birth, newborn asphyxia, neonatal intensive care unit hospitalization, meconium-stained amniotic fluid, and low birth weight in the three groups (P < 0.05). Furthermore, severe and extremely severe ICP with hypotonic absonant uterine contraction had a significant effect on neonatal asphyxia (odds ratio, 5.06 [95% confidence interval, 1.09-23.37]; P < 0.05) and meconium-stained amniotic fluid (odds ratio, 2.37 [95% confidence interval, 1.43-3.93]; P < 0.05). CONCLUSIONS Hypotonic absonant uterine contractions could be high-risk stressors for severe and extremely severe ICP; hence, proper prenatal care is recommended. Risk-stratified management strategies for ICP are critical to obtaining better maternal-fetal outcomes.
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Affiliation(s)
- Tingting Xu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan, China
| | - Yongchi Zhan
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan, China
| | - Daijuan Chen
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan, China
| | - Xixi Deng
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan, China
| | - Chihui Mao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan, China
| | - Jinfeng Xu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan, China
| | - Xing Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Bing Guo
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xiaodong Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan, China
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Chen S, Ahlqvist VH, Sjöqvist H, Stephansson O, Magnusson C, Dalman C, Karlsson H, Lee BK, Gardner RM. Maternal intrahepatic cholestasis of pregnancy and neurodevelopmental conditions in offspring: A population-based cohort study of 2 million Swedish children. PLoS Med 2024; 21:e1004331. [PMID: 38227577 PMCID: PMC10790993 DOI: 10.1371/journal.pmed.1004331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/06/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Intrahepatic cholestasis of pregnancy (ICP) is the most common obstetric liver disorder and is associated with an increased risk of iatrogenic preterm birth and adverse infant outcomes. Hence, there are several plausible pathways through which ICP could affect offspring neurodevelopment. However, to the best of our knowledge, no studies have investigated these associations. Thus, we aimed to determine whether ICP is associated with offspring neurodevelopmental conditions. METHODS AND FINDINGS In this Swedish register-based cohort study, we included singleton non-adopted children born in Sweden between the 1st of January 1987 and the 31st of December 2010, who were resident in Sweden >5 years, with no missing covariate information, which we followed until the 31st of December 2016. Maternal ICP diagnosis and the date of the initial diagnosis during pregnancy were obtained from the National Patient Register. Offspring diagnoses of attention deficit/hyperactivity disorder (ADHD), autism, or intellectual disability were obtained from the National Patient Register, and the dispensation of ADHD medications were obtained from the Prescribed Drug Register. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression while controlling for observed confounders and unobserved confounders shared among full siblings and maternal full cousins. A total of 2,375,856 children were included in the study; 81.6% of them were of Nordic origin, and 51.4% were male. Of these, 10,378 (0.44%) were exposed to ICP. During a median of 18 years follow-up (interquartile range 11 to 24), 143,746 (6.05%) of children were diagnosed with a neurodevelopmental condition. After adjusting for child's sex, birth year, birth month, maternal age, highest parental education level, maternal birth country, birth order, maternal psychiatric history, ICP was associated with increased odds of offspring neurodevelopmental conditions (OR 1.22, 95% CI 1.13 to 1.31), particularly among those exposed to early-onset ICP (OR 2.38, 95% CI 1.71 to 3.30) as compared to ICP diagnosed after reaching term (≥37 weeks of gestation) (OR 1.08, 95% CI 0.97 to 1.20). The findings of early-onset ICP were consistent in family-based analyses. Within-family comparisons of full maternal cousins yielded an OR of 2.99 (95% CI 1.48 to 6.04), and comparisons of full siblings showed an OR of 1.92 (95% CI 0.92 to 4.02), though the latter was less precise. The findings were consistent across specific neurodevelopmental conditions and different analytical approaches. The primary limitations of this study included its observational design, the absence of data on ICP therapeutics, and the lack of bile acid measures. CONCLUSIONS In this study, we observed that exposure to ICP during gestation is associated with an increased likelihood of neurodevelopmental conditions in offspring, particularly in cases of early-onset ICP. Further studies are warranted to better understand the role of early-ICP in offspring neurodevelopment.
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Affiliation(s)
- Shuyun Chen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Viktor H. Ahlqvist
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Hugo Sjöqvist
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women’s Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Magnusson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Christina Dalman
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Håkan Karlsson
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Brian K. Lee
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, United States of America
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, United States of America
| | - Renee M. Gardner
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Li P, Jiang Y, You Y. Serum placental growth factor, total cholesterol, and triglycerides for prediction of intrahepatic cholestasis of pregnancy. Medicine (Baltimore) 2023; 102:e36178. [PMID: 38115361 PMCID: PMC10727609 DOI: 10.1097/md.0000000000036178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 12/21/2023] Open
Abstract
This study aims to investigate the predictive values of serum placental growth factor (PIGF), total cholesterol (TC), and triglycerides (TG) in the context of intrahepatic cholestasis of pregnancy (ICP). This retrospective case control study recruited pregnant women from January 2021 to December 2021 at the Maternal and Child Health Hospital of Hunan Province, encompassing pregnant women diagnosed with ICP and those with unremarkable prenatal examinations. A total of 433 pregnant women were included, among whom 167 were diagnosed with ICP after 24 weeks of pregnancy. Patients with ICP exhibited an average age of 31.30 ± 4.54 years and an average pregnancy week at delivery of 37.63 ± 1.45 weeks. Multivariable regression analysis showed that the pregnancy week at delivery (OR = 0.823, 95% CI: 0.769-0.879, P < .001), PIGF (OR = 0.994, 95% CI: 0.992-0.996, P < .001), TC (OR = 1.955, 95% CI: 1.586-2.409, P < .001), and TG (OR = 3.786, 95% CI: 2.655-5.399, P < .001) were independent risk factors for ICP. The area under the curve values for PIGF, TC, and TG in predicting ICP were 0.858 (95% CI: 0.822-0.893), 0.721 (95% CI: 0.670-0.772), and 0.830 (95% CI: 0.788-0.871), respectively. However, their combination yielded an area under the curve value of 0.922 (95% CI: 0.898-0.946). The composite assessment of PIGF, TC, and TG demonstrates potential efficacy in predicting ICP among pregnant women.
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Affiliation(s)
- Ping Li
- Obstetrics Department, the Maternal and Child Health Hospital of Hunan Province, Changsha, China
| | - Yurong Jiang
- Obstetrics Department, the Maternal and Child Health Hospital of Hunan Province, Changsha, China
| | - Yiping You
- Obstetrics Department, the Maternal and Child Health Hospital of Hunan Province, Changsha, China
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Niemyjska-Dmoch W, Kosiński P, Węgrzyn P, Luterek K, Jezela-Stanek A. Intrahepatic cholestasis of pregnancy and theory of inheritance of the disease. Literature review. J Matern Fetal Neonatal Med 2023; 36:2279020. [PMID: 37945319 DOI: 10.1080/14767058.2023.2279020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
Intrahepatic cholestasis during pregnancy is associated with a higher risk of prenatal and maternal complications. There are several new publications and guidelines on the detection and thresholds of intrahepatic cholestasis during pregnancy. However, the genetic background of this disease has rarely been investigated. This is a comprehensive review of the roles of genes in intrahepatic cholestasis during pregnancy.
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Affiliation(s)
- Weronika Niemyjska-Dmoch
- Department of Obstetrics, Perinatology and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Przemysław Kosiński
- Department of Obstetrics, Perinatology and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Węgrzyn
- Department of Obstetrics, Perinatology and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Luterek
- Department of Obstetrics, Perinatology and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Jezela-Stanek
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
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Sentilhes L, Sénat MV, Bouchghoul H, Delorme P, Gallot D, Garabedian C, Madar H, Sananès N, Perrotin F, Schmitz T. [Intrahepatic cholestasis of pregnancy: French College of Obstetricians and Gynecologists guidelines for clinical practice]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:493-510. [PMID: 37806861 DOI: 10.1016/j.gofs.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To identify strategies for reducing neonatal and maternal morbidity associated with intrahepatic cholestasis pregnancy (ICP). MATERIAL AND METHODS The quality of evidence of the literature was assessed following the GRADE methodology with questions formulated in the PICO format (Patients, Intervention, Comparison, Outcome) and outcomes defined a priori and classified according to their importance. An extensive bibliographic search was performed on PubMed, Cochrane, EMBASE and Google Scholar databases. The quality of the evidence was assessed (high, moderate, low, very low) and a (i) strong or (ii) weak recommendations or (iii) no recommendation were formulated. The recommendations were reviewed in two rounds with external reviewers (Delphi survey) to select the consensus recommendations. RESULTS Of the 14 questions (from 12 PICO questions and one definition question outside the PICO format), there was agreement between the working group and the external reviewers on 14 (100%). The level of evidence of the literature was insufficient to provide a recommendation on two questions. ICP is defined by the occurrence of suggestive pruritus (palmoplantar, nocturnal) associated with a total bile acid level>10μmol/L or an alanine transaminase level above 2N after ruling out differential diagnoses. In the absence of suggestive symptoms of a differential diagnosis, it is recommended not to carry out additional biological or ultrasound tests. In women with CIP, ursodeoxycholic acid is recommended to reduce the intensity of maternal pruritus (Strong recommendation. Quality of the evidence moderate) and to decrease the level of total bile acids and alanine transaminases. (Strong recommendation. Quality of the evidence moderate). S-adenosyl-methionine, dexamethasone, guar gum or activated charcoal should not be used to reduce the intensity of maternal pruritus (Strong recommendation. Quality of evidence low), and there is insufficient data to recommend the use of antihistamines (No recommendation. Quality of evidence low). Rifampicin (Weak recommendation. Very low quality of evidence) or plasma exchange (Strong recommendation. Very low quality of evidence) should not be used to reduce maternal pruritus and perinatal morbidity. Serum monitoring of bile acids is recommended to reduce perinatal morbidity and mortality (stillbirth, prematurity) (Low recommendation. Quality of the evidence low). The level of evidence is insufficient to determine whether fetal heart rate or fetal ultrasound monitoring are useful to reduce perinatal morbidity (No recommendation). Birth is recommended when bile acid level is above 99μmol/L from 36 weeks gestation to reduce perinatal morbidity, in particular stillbirth. When bile acid level is above 99μmol/L is below 100μmol/L, women should be informed that induction of labor could be considered 37 and 39 weeks gestation to reduce perinatal morbidity. (Strong recommendation. Quality of evidence low). In postpartum, total bile acids and alanine transaminases level should be checked and normalized before prescribing estrogen-progestin contraception, ideally with a low estrogen dose (risk of recurrence of pruritus and cytolysis) (Low recommendation. Quality of evidence very low). CONCLUSION Although the quality of evidence regarding ICP gestational cholestasis remains low, there is a strong consensus in France, as shown by our Delphi study, on how to manage women with ICP. The reference first-line treatment is ursodeoxycholic acid.
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Affiliation(s)
- L Sentilhes
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France.
| | - M-V Sénat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - H Bouchghoul
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - P Delorme
- Service de gynécologie-obstétrique, hôpital Trousseau, AP-HP, Paris, France
| | - D Gallot
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - C Garabedian
- Service de gynécologie-obstétrique, CHU de Lille, université de Lille, ULR 2694-METRICS, 59000 Lille, France
| | - H Madar
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - N Sananès
- Service de gynécologie-obstétrique, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - F Perrotin
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Tours, Tours, France
| | - T Schmitz
- Service de gynécologie obstétrique, hôpital Robert-Debré, AP-HP, Paris, France
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Obiegbusi CN, Dong XJ, Obiegbusi SC. Pregnancy outcomes following antenatal screening for intrahepatic cholestasis of pregnancy (ICP). Taiwan J Obstet Gynecol 2023; 62:809-816. [PMID: 38008498 DOI: 10.1016/j.tjog.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 11/28/2023] Open
Abstract
OBJECTIVE To evaluate the maternal and perinatal outcomes following antenatal screening for ICP using a retrospective approach. MATERIALS AND METHODS A retrospective study was conducted at the second affiliated hospital of Chongqing Medical University, Chongqing, China, from 2012 to 2017. Pregnant women registered for antenatal in our hospital were screened for ICP. The pregnant women with detailed delivery record and presenting with the diagnosis of ICP based on TBA level ≥10 mmol/L and abnormal liver enzymes were included in the study. METHOD The pregnant women with detailed delivery records presenting with the diagnosis of ICP based on TBA level ≥10 mmol/L and abnormal liver enzymes were included in the study. 1410 pregnant women were enrolled in this study. We selected 940 pregnant women without the diagnosis of ICP as our control and 470 pregnant women diagnosed with ICP as our case study. Data collection and sampling in the control group was done using microsoft excel (version 16.61) random number generator. RESULTS The mean age of the pregnant women and the gestational age at the time of diagnosis of ICP were 29.01 ± 4.3 years and 31.90 ± 8.83 weeks, respectively. It was found that a significant number of patients with ICP had a preterm birth and low birth weight (LBW), n = 151 (32.5%) P < 0.001 and n = 70 (14.9%) P < 0.001, respectively. A significant number of patients in the case group had a history of liver disease and gall bladder disease, p < 0.001 and p = 0.005, respectively, and a higher rate of GDM p < 0.001. Despite treatment, high TBA titer among ICP patients was associated with preterm delivery. CONCLUSION ICP in pregnancy leads to complications and poor perinatal outcomes. Fetal outcomes depend on the TBA levels; therefore, early diagnosis of ICP through routine screening followed by treatment is recommended in high-risk persons/areas.
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Affiliation(s)
- Chidera Nneji Obiegbusi
- The Second Affiliated Hospital of Chongqing Medical University, 288 Tianwen Avenue, Jiangnan Xincheng, Zone B, Chayuan, Nan'an District, Chongqing, China.
| | - Xiao Jing Dong
- The Second Affiliated Hospital of Chongqing Medical University, 288 Tianwen Avenue, Jiangnan Xincheng, Zone B, Chayuan, Nan'an District, Chongqing, China; The Second Affiliated Hospital of Chongqing Medical University, No.76 LinJiang Road, YuZhong District, Chongqing, China.
| | - Samuel Chigbo Obiegbusi
- The Second Affiliated Hospital of Chongqing Medical University, 288 Tianwen Avenue, Jiangnan Xincheng, Zone B, Chayuan, Nan'an District, Chongqing, China.
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Arbuzova S, Nikolenko M, Wright D, Cuckle H. Cholelithiasis is an additional pre-pregnancy clinical risk factor for preeclampsia. Arch Gynecol Obstet 2023; 308:1497-1503. [PMID: 36708426 PMCID: PMC10520082 DOI: 10.1007/s00404-023-06936-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 01/15/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE To investigate additional potential clinical risk factors for preeclampsia. METHODS This is a nested case-control study of preeclampsia and unaffected pregnancies. Cases were either from a prenatal screening database or from a national network of clinicians, and controls were from the same prenatal source. Preeclampsia was defined by international criteria which were endorsed by the Ukraine Ministry of Health. Questionnaires were used to record a range of pregnancy related factors, personal history of health conditions and family history, followed by a telephone interview to collect more details. RESULTS There were 103 cases, 56 from the prenatal database and 47 from the clinicians, and 480 controls from the database. The two types of case did not differ in terms of age, weight, BMI or parity. Known risk factors were more common in cases than controls. In addition there was a 17-fold higher prevalence of cholelithiasis in cases compared with controls (29.1% versus 1.7%), a highly statistically significant difference (P < 0.0001). There was also an 8.8-fold increase among the mothers of cases and controls (P < 0.0001), and if either the patient or her mother had the disease the increase was 6.4-fold (P < 0.0001). Including the father or sibling did not increase the relative risk. CONCLUSION Cholelithiasis is a clinical risk factor for preeclampsia which has not previously been reported. If confirmed by additional studies it may have utility in routine prenatal screening and provide insight into the pathogenesis of preeclampsia.
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Affiliation(s)
- Svitlana Arbuzova
- Eastern-Ukrainian Center for Medical Genetics and Prenatal Diagnosis, Mariupol & Kiev, Ukraine.
- Institute of Health Research, University of Exeter, Exeter, England.
| | - Margaryta Nikolenko
- Eastern-Ukrainian Center for Medical Genetics and Prenatal Diagnosis, Mariupol & Kiev, Ukraine
| | - David Wright
- Institute of Health Research, University of Exeter, Exeter, England
| | - Howard Cuckle
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Goins EC, Wein LE, Watkins VY, Campbell AIK, Heine RP, Hughes BL, Dotters-Katz SK, Federspiel JJ. Maternal and neonatal outcomes in patients with hepatitis C and intrahepatic cholestasis of pregnancy: The sum of the parts. PLoS One 2023; 18:e0293030. [PMID: 37851654 PMCID: PMC10584137 DOI: 10.1371/journal.pone.0293030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVE Hepatitis C virus and intrahepatic cholestasis of pregnancy (ICP) are well-known independent risk factors for adverse outcomes in pregnancy. In addition, it is well-established that there is an association between Hepatitis C and ICP. This study's objective was to describe the impact of having both Hepatitis C and ICP on maternal and obstetric outcomes compared to patients having either Hepatitis C or ICP. METHODS We conducted a retrospective cohort study of the Nationwide Readmissions Database, an all-payor sample of discharges from approximately 60% of US hospitalizations. Deliveries at 24-42+ weeks between 10/2015 and 12/2020 were included. Diagnosis of Hepatitis C and ICP, and outcomes related to severe maternal morbidity were identified using International Classification of Disease-10 codes. Patients were categorized based on Hepatitis C and ICP status. Weighted logistic and negative binomial regression analyses were used to evaluate the association between Hepatitis C and ICP status and outcomes, adjusting for patient and hospital characteristics. The primary outcome was any severe maternal morbidity; secondary outcomes included acute respiratory distress syndrome, acute kidney injury, sepsis, gestational diabetes, cesarean delivery, preterm birth, and hospital length of stay. We modeled interaction terms between ICP and Hepatitis C to assess whether there was a greater or lesser effect from having both conditions on outcomes than we would expect from additive combination of the individual components (i.e., synergy or antagonism). RESULTS A total of 10,040,850 deliveries between 24-42+ weeks were identified. Of these, 45,368 had Hepatitis C only; 84,582 had ICP only; and 1,967 had both Hepatitis C and ICP. Patients with both Hepatitis C and ICP had 1.5-fold higher odds of developing severe maternal morbidity compared to having neither. There was an also an increased odds of severe maternal morbidity in patients with both Hepatitis C and ICP compared to patients with only Hepatitis C or ICP. Having both was also associated with higher odds of preterm birth and length of stay compared to having only Hepatitis C, only ICP, or neither (preterm birth: aOR 5.09, 95% CI 4.87-5.33 vs. neither; length of stay: 46% mean increase, 95% CI 35-58% vs. neither). Associations were additive-no significant interactions between hepatitis C and cholestasis were found on rates of severe maternal morbidity, acute respiratory distress syndrome, acute kidney injury, sepsis, cesarean section, or preterm birth (all p>0.05), and was minimal for gestational diabetes and length of stay. CONCLUSION Hepatitis C and ICP are independent, additive risk factors for adverse maternal and obstetric outcomes. Despite physiologic plausibility, no evidence of a synergistic effect of these two diagnoses on outcomes was noted. These data may be useful in counseling patients regarding their increased risk of adverse outcomes when ICP presents in association with Hepatitis C versus ICP alone.
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Affiliation(s)
- Emily C. Goins
- Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Lauren E. Wein
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Virginia Y. Watkins
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Alexa I. K. Campbell
- Duke University School of Medicine, Durham, North Carolina, United States of America
| | - R. Phillips Heine
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Brenna L. Hughes
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Sarah K. Dotters-Katz
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Jerome Jeffrey Federspiel
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
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Xiong L, Tang M, Xing S, Yang X. The role of noncoding RNA and its diagnostic potential in intrahepatic cholestasis of pregnancy: a research update. Front Genet 2023; 14:1239693. [PMID: 37900174 PMCID: PMC10611463 DOI: 10.3389/fgene.2023.1239693] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Intrahepatic cholestasis of pregnancy (ICP) is a common liver disorder that generally occurs during the second or third trimester of pregnancy. It rarely causes any harm to the mother; however, it can result in short- and long-term complications in the offspring. Therefore, it is crucial to diagnose and treat this condition to avoid poor pregnancy outcomes. The identification of novel markers with potential diagnostic, prognostic, and therapeutic utility in ICP has gained attention. Noncoding RNAs (ncRNAs), including microRNA, long noncoding RNA, and circular RNA, are a type of transcripts that are not translated into proteins. They possess vital biological functions, including transcriptional and translational regulation and DNA, RNA, and protein interactions. The pathogenesis of ICP is related to the aberrant expression of several circulating or placenta-related ncRNAs. In this review, we summarized all recent findings on ncRNAs and ICP and outlined the concepts that form the basis for the early diagnosis and targeted treatment of ICP.
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Affiliation(s)
- Liling Xiong
- Obstetrics Department, Chengdu Women’s and Children’s Center Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Mi Tang
- GCP Institution, Chengdu Women’s and Children’s Center Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shasha Xing
- GCP Institution, Chengdu Women’s and Children’s Center Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiao Yang
- Obstetrics Department, Chengdu Women’s and Children’s Center Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Li X, Xie H, Chao JJ, Jia YH, Zuo J, An YP, Bao YR, Jiang X, Ying H. Profiles and integration of the gut microbiome and fecal metabolites in severe intrahepatic cholestasis of pregnancy. BMC Microbiol 2023; 23:282. [PMID: 37784030 PMCID: PMC10546765 DOI: 10.1186/s12866-023-02983-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/17/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND The pathogenesis of intrahepatic cholestasis of pregnancy (ICP) remains unknown. The gut microbiome and its metabolites play important roles in bile acid metabolism, and previous studies have indicated the association of the gut microbiome with ICP. METHODS We recruited a cohort of 5100 participants, and 20 participants were enrolled in the severe ICP group, matched with 20 participants in the mild ICP group and 20 controls. 16S rRNA sequencing and nontargeting metabolomics were adapted to explore the gut microbiome and fecal metabolites. RESULTS An increase in richness and a dramatic deviation in composition were found in the gut microbiome in ICP. Decreased Firmicutes and Bacteroidetes abundances and increased Proteobacteria abundances were found in women with severe but not mild ICP compared to healthy pregnant women. Escherichia-Shigella and Lachnoclostridium abundances increased, whereas Ruminococcaceae abundance decreased in ICP group, especially in severe ICP group. The fecal metabolite composition and diversity presented typical variation in severe ICP. A significant increase in bile acid, formate and succinate levels and a decrease in butyrate and hypoxanthine levels were found in women with severe ICP. The MIMOSA model indicated that genera Ruminococcus gnavus group, Lachnospiraceae FCS020 group, and Lachnospiraceae NK4A136 group contributed significantly to the metabolism of hypoxanthine, which was significantly depleted in subjects with severe ICP. Genus Acinetobacter contributed significantly to formate metabolism, which was significantly enriched in subjects with severe ICP. CONCLUSIONS Women with severe but not mild ICP harbored a unique gut microbiome and fecal metabolites compared to healthy controls. Based on these profiles, we hypothesized that the gut microbiome was involved in bile acid metabolism through metabolites, affecting ICP pathogenesis and development, especially severe ICP.
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Affiliation(s)
- Xiang Li
- Shanghai Key Laboratory of Maternal Fetal Medicine Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai, 200040, China
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No. 2699, West Gaoke Road, Shanghai, 200040, People's Republic of China
| | - Han Xie
- Shanghai Key Laboratory of Maternal Fetal Medicine Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai, 200040, China
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No. 2699, West Gaoke Road, Shanghai, 200040, People's Republic of China
| | - Jia-Jing Chao
- Shanghai Key Laboratory of Maternal Fetal Medicine Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai, 200040, China
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No. 2699, West Gaoke Road, Shanghai, 200040, People's Republic of China
| | - Yuan-Hui Jia
- Shanghai Key Laboratory of Maternal Fetal Medicine Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai, 200040, China
- Clinical and Translational Research Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200040, China
| | - Jia Zuo
- Shanghai Key Laboratory of Maternal Fetal Medicine Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai, 200040, China
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No. 2699, West Gaoke Road, Shanghai, 200040, People's Republic of China
| | - Yan-Peng An
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, 200438, China
| | - Yi-Rong Bao
- Shanghai Key Laboratory of Maternal Fetal Medicine Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai, 200040, China
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No. 2699, West Gaoke Road, Shanghai, 200040, People's Republic of China
| | - Xiang Jiang
- Shanghai Key Laboratory of Maternal Fetal Medicine Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai, 200040, China.
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No. 2699, West Gaoke Road, Shanghai, 200040, People's Republic of China.
- Clinical and Translational Research Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200040, China.
| | - Hao Ying
- Shanghai Key Laboratory of Maternal Fetal Medicine Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai, 200040, China.
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No. 2699, West Gaoke Road, Shanghai, 200040, People's Republic of China.
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White SW. Intrahepatic cholestasis of pregnancy: Contemporary management. Aust N Z J Obstet Gynaecol 2023; 63:623-624. [PMID: 37775914 DOI: 10.1111/ajo.13753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Scott W White
- The Western Australian Centre for Health Research for Women and Babies, The University of Western Australia, Perth, Western Australia, Australia
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
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Hague WM, Briley A, Callaway L, Dekker Nitert M, Gehlert J, Graham D, Grzeskowiak L, Makris A, Markus C, Middleton P, Peek MJ, Shand A, Stark M, Waugh J. Intrahepatic cholestasis of pregnancy - Diagnosis and management: A consensus statement of the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ): Executive summary. Aust N Z J Obstet Gynaecol 2023; 63:656-665. [PMID: 37431680 DOI: 10.1111/ajo.13719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/24/2023] [Indexed: 07/12/2023]
Abstract
Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy liver disease, characterised by pruritus and increased total serum bile acids (TSBA), Australian incidence 0.6-0.7%. ICP is diagnosed by non-fasting TSBA ≥19 μmol/L in a pregnant woman with pruritus without rash without a known pre-existing liver disorder. Peak TSBA ≥40 and ≥100 μmol/L identify severe and very severe disease respectively, associated with spontaneous preterm birth when severe, and with stillbirth, when very severe. Benefit-vs-risk for iatrogenic preterm birth in ICP remains uncertain. Ursodeoxycholic acid remains the best pharmacotherapy preterm, improving perinatal outcome and reducing pruritus, although it has not been shown to reduce stillbirth.
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Affiliation(s)
- William M Hague
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Annette Briley
- Women's Health & Midwifery Research, College of Nursing & Health Sciences, Bedford Park, South Australia, Australia
| | - Leonie Callaway
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Marloes Dekker Nitert
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Jessica Gehlert
- Department of Obstetrics and Gynaecology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Dorothy Graham
- King Edward Memorial Hospital, Subiaco, Western Australia, Australia
| | - Luke Grzeskowiak
- College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Angela Makris
- Liverpool Hospital, Sydney, New South Wales, Australia
| | - Corey Markus
- College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Philippa Middleton
- SA Health and Medical Research Institute, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Michael J Peek
- College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Antonia Shand
- Department of Maternal Fetal Medicine, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Michael Stark
- Women's and Children's Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jason Waugh
- Auckland City Hospital, Auckland, New Zealand
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46
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Estin ML, Campbell AIK, Watkins VY, Dotters-Katz SK, Brady CW, Federspiel JJ. Risk of stillbirth in United States patients with diagnosed intrahepatic cholestasis of pregnancy. Am J Obstet Gynecol 2023; 229:453.e1-453.e8. [PMID: 37348778 PMCID: PMC10651178 DOI: 10.1016/j.ajog.2023.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Intrahepatic cholestasis of pregnancy is associated with a 4- to 10-fold increase in the risk of stillbirth in the absence of intervention, leading to recommendations for antenatal assessment, ursodiol use, and often preterm or early term delivery. OBJECTIVE This study aimed to determine whether current management strategies for intrahepatic cholestasis of pregnancy mitigate the elevated risk of stillbirth at a population level. STUDY DESIGN This was a retrospective cohort study using the 2015-2020 National Readmissions Database, an administrative database developed by the United States Agency for Healthcare Research and Quality. Our study identified delivery hospitalizations, gestational age at delivery, occurrence of intrahepatic cholestasis of pregnancy and stillbirth, and comorbid conditions using the International Classification of Diseases diagnosis and procedure codes. Moreover, this study compared the timing of delivery and stillbirth rates of pregnant patients with intrahepatic cholestasis of pregnancy vs those without intrahepatic cholestasis of pregnancy at the time of delivery hospitalization. RESULTS This study identified a cohort of 9,987,705 delivery hospitalizations in the National Readmissions Database, corresponding to a weighted national estimate of 18,609,207 births. Of these births, 152,040 (0.8%) were noted to have an intrahepatic cholestasis of pregnancy diagnosis. Patients with an intrahepatic cholestasis of pregnancy diagnosis were older, with small differences in comorbidities, such as a higher rate of gestational diabetes mellitus, than patients without an intrahepatic cholestasis of pregnancy diagnosis at delivery hospitalization. The overall rates of stillbirth were lower among those with intrahepatic cholestasis of pregnancy than among those without intrahepatic cholestasis of pregnancy (252 vs 386 per 100,000 deliveries; risk difference, 133 fewer per 100,000 deliveries; 95% confidence interval, 98-170), a finding that persisted after adjustment for insurance status, socioeconomic factors, and comorbid conditions (risk difference, 160 fewer stillbirths per 100,000 deliveries; 95% confidence interval, 127-194). Furthermore, although patients with intrahepatic cholestasis of pregnancy were more likely to deliver before term than those without intrahepatic cholestasis of pregnancy (30.1% vs 9.3%; P<.001), increased rates of stillbirth were not noted at any point after stratification of the cohort by gestational age at delivery. CONCLUSION Patients with intrahepatic cholestasis of pregnancy diagnosis codes delivered earlier than those without intrahepatic cholestasis of pregnancy diagnosis codes, but the percentage of births affected by stillbirth was lower, even when stratifying for gestational age at birth. These results may provide reassurance to patients receiving an intrahepatic cholestasis of pregnancy diagnosis that current management does mitigate stillbirth risk in intrahepatic cholestasis of pregnancy.
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Affiliation(s)
| | | | | | | | - Carla W Brady
- Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Jerome J Federspiel
- Departments of Obstetrics and Gynecology; Population Health Sciences, Duke University School of Medicine, Durham, NC
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Yadav I, Yadav SK, Pradhan T, Yadav A, Jyoti S, Yadav R. Obstetric Cholestasis among Pregnant Women Visiting a Tertiary Care Centre. JNMA J Nepal Med Assoc 2023; 61:750-754. [PMID: 38289786 PMCID: PMC10579757 DOI: 10.31729/jnma.8283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Obstetric cholestasis is one of the most frequent hepatic disorders specific to pregnancy. It occurs commonly during the latter half of pregnancy. The data regarding this issue is rare in our settings. The aim of this study was to find out the prevalence of obstetric cholestasis among pregnant women visiting a tertiary care centre. Methods A descriptive cross-sectional study was conducted among pregnant women, who attended a tertiary care centre from 24 July 2022 to 24 January 2023. Ethical approval was taken from the Institutional Review Committee of the same institute. Convenience sampling method was used. The point estimate was calculated at a 99% Confidence Interval. Results The prevalence of obstetric cholestasis was 80 (1.38%) (1-1.80, 99% Confidence Interval). A total of 40 (50%) were in the age group 21-30 years, with a mean age of 28.06±6.39 years. A total of 48 (60%) were multigravida and 73 (91.30%) had singleton pregnancies. Pruritus of the whole body was complained of by 56 (70%) patients. Previous history of obstetric cholestasis was present in 21 (26.30%). Conclusions The prevalence of obstetric cholestasis among pregnant women is lower than other studies done in similar settings. Keywords Nepal; obstetric cholestasis; pregnancy.
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Affiliation(s)
- Indra Yadav
- Department of Obstetrics and Gynaecology, Birat Medical College and Teaching Hospital, Biratnagar, Morang, Nepal
| | - Siddhartha Kumar Yadav
- Department of Obstetrics and Gynaecology, Birat Medical College and Teaching Hospital, Biratnagar, Morang, Nepal
| | - Tarun Pradhan
- Department of Obstetrics and Gynaecology, Birat Medical College and Teaching Hospital, Biratnagar, Morang, Nepal
| | - Anika Yadav
- Department of Paediatrics, ChitWan Medical College, Bharatpur, Chitwan, Nepal
| | - Sabita Jyoti
- Department of Community Medicine, Nepalgunj Medical College Teaching Hospital, Nepalgunj, Banke, Nepal
| | - Rozy Yadav
- Department of Obstetrics and Gynaecology, Karnali Province Hospital, Birendranagar, Sublet, Nepal
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48
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Dajti E, Bruni A, Barbara G, Azzaroli F. Diagnostic Approach to Elevated Liver Function Tests during Pregnancy: A Pragmatic Narrative Review. J Pers Med 2023; 13:1388. [PMID: 37763154 PMCID: PMC10532949 DOI: 10.3390/jpm13091388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/09/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Liver disease is not uncommon during pregnancy and is associated with increased maternal and fetal/neonatal morbidity and mortality. Physiological changes during pregnancy, including a hyperestrogenic state, increase in circulating plasma volume and/or reduction in splanchnic vascular resistance, and hemostatic imbalance, may mimic or worsen liver disease. For the clinician, it is important to distinguish among the first presentation or exacerbation of chronic liver disease, acute liver disease non-specific to pregnancy, and pregnancy-specific liver disease. This last group classically includes conditions such as hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, liver disorders associated with the pre-eclampsia spectrum, and an acute fatty liver of pregnancy. All of these disorders often share pathophysiological mechanisms, symptoms, and laboratory findings (such as elevated liver enzymes), but a prompt and correct diagnosis is fundamental to guide obstetric conduct, reduce morbidity and mortality, and inform upon the risk of recurrence or development of other chronic diseases later on in life. Finally, the cause of elevated liver enzymes during pregnancy is unclear in up to 30-40% of the cases, and yet, little is known on the causes and mechanisms underlying these alterations, or whether these findings are associated with worse maternal/fetal outcomes. In this narrative review, we aimed to summarize pragmatically the diagnostic work-up and the management of subjects with elevated liver enzymes during pregnancy.
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Affiliation(s)
- Elton Dajti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, European Reference Network on Hepatological Diseases (ERN RARE-LIVER), 40138 Bologna, Italy; (A.B.); (G.B.); (F.A.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
| | - Angelo Bruni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, European Reference Network on Hepatological Diseases (ERN RARE-LIVER), 40138 Bologna, Italy; (A.B.); (G.B.); (F.A.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
| | - Giovanni Barbara
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, European Reference Network on Hepatological Diseases (ERN RARE-LIVER), 40138 Bologna, Italy; (A.B.); (G.B.); (F.A.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
| | - Francesco Azzaroli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, European Reference Network on Hepatological Diseases (ERN RARE-LIVER), 40138 Bologna, Italy; (A.B.); (G.B.); (F.A.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
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Williamson C, Nana M, Poon L, Kupcinskas L, Painter R, Taliani G, Heneghan M, Marschall HU, Beuers U. EASL Clinical Practice Guidelines on the management of liver diseases in pregnancy. J Hepatol 2023; 79:768-828. [PMID: 37394016 DOI: 10.1016/j.jhep.2023.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 07/04/2023]
Abstract
Liver diseases in pregnancy comprise both gestational liver disorders and acute and chronic hepatic disorders occurring coincidentally in pregnancy. Whether related to pregnancy or pre-existing, liver diseases in pregnancy are associated with a significant risk of maternal and fetal morbidity and mortality. Thus, the European Association for the Study of Liver Disease invited a panel of experts to develop clinical practice guidelines aimed at providing recommendations, based on the best available evidence, for the management of liver disease in pregnancy for hepatologists, gastroenterologists, obstetric physicians, general physicians, obstetricians, specialists in training and other healthcare professionals who provide care for this patient population.
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McGuire B. Updates on Evaluation and Treatment of Common Complaints in Pregnancy. Obstet Gynecol Clin North Am 2023; 50:535-547. [PMID: 37500215 DOI: 10.1016/j.ogc.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Patients experience many new and concerning symptoms during pregnancy and it is the role of the obstetric clinician to provide appropriate guidance, recommendations, and treatment options. Often times, these symptoms are related to hormonal and physiologic changes that occur and will resolve in the postpartum period. However, clinicians must be able to recognize more concerning pathologic symptoms that require further evaluation and treatment. This review provides updates on the evaluation and management of some of the common symptoms during pregnancy.
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Affiliation(s)
- Brenna McGuire
- Department of Obstetrics and Gynecology, University of New Mexico Hospital, UNM Obstetrics & Gynecology, MSC10 5580, 1 University of New Mexico, Albuquerque, NM 87131, USA.
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