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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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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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Dumančić S, Mikuš M, Palčić Z, Habek D, Tešanović M, Mimica MD, Marušić J. Severe Early-Onset Intrahepatic Cholestasis of Pregnancy Following Ovarian Hyperstimulation Syndrome with Pulmonary Presentation after In Vitro Fertilization: Case Report and Systematic Review of Case Reports. Life (Basel) 2024; 14:129. [PMID: 38255744 PMCID: PMC10820620 DOI: 10.3390/life14010129] [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: 11/23/2023] [Revised: 01/03/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy-related liver disease, usually presented in the third trimester with pruritus, elevated transaminase, and serum total bile acids. Evidence shows that it can be developed in the first trimester, more commonly after in vitro fertilization (IVF) procedures, with the presence of ovarian hyperstimulation syndrome (OHSS). METHODS A literature search was conducted in the PubMed/MEDLINE database of case reports/studies reporting early-onset ICP in spontaneous and IVF pregnancies published until July 2023. RESULTS Thirty articles on early-onset ICP were included in the review analysis, with 19 patients who developed ICP in spontaneous pregnancy and 15 patients who developed ICP in IVF pregnancies with or without OHSS. Cases of 1st and 2nd trimester ICP in terms of "early-onset" ICP were pooled to gather additional findings. CONCLUSIONS Proper monitoring should be applied even before expected pregnancy and during IVF procedures in patients with known risk factors for OHSS and ICP development (patient and family history), with proper progesterone supplementation dosage and genetic testing in case of ICP recurrence.
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Affiliation(s)
- Stipe Dumančić
- Department of Obstetrics and Gynecology, Clinical Hospital Center Split, 21 000 Split, Croatia; (S.D.); (M.D.M.)
| | - Mislav Mikuš
- Department of Obstetrics and Gynecology, Clinical Hospital Center Zagreb, 10 000 Zagreb, Croatia
| | - Zdenka Palčić
- Department of Obstetrics and Gynecology, Clinical Hospital Center Split, 21 000 Split, Croatia; (S.D.); (M.D.M.)
| | - Dubravko Habek
- School of Medicine, Catholic University of Croatia, Ilica 242, 10 000 Zagreb, Croatia;
| | - Mara Tešanović
- Department of Obstetrics and Gynecology, General Hospital Dubrovnik, 20 000 Dubrovnik, Croatia;
| | - Marko Dražen Mimica
- Department of Obstetrics and Gynecology, Clinical Hospital Center Split, 21 000 Split, Croatia; (S.D.); (M.D.M.)
| | - Jelena Marušić
- Department of Obstetrics and Gynecology, Clinical Hospital Center Split, 21 000 Split, Croatia; (S.D.); (M.D.M.)
- School of Medicine, University of Split, Soltanska 2, 21 000 Split, Croatia
- University Department of Health Studies, University of Split, R. Boskovica 35, 21 000 Split, Croatia
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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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Sun J, Wang W, Zhou X, Yang T, Ye M, Shi W, Liu Z, Zhang L, Zhou Q, Qin Y, Chen Y, Chen F, Huang H, Chen S, Xu C. Early characterisation and prediction of liver diseases in pregnancy by plasma cell-free RNAs. Clin Transl Med 2023; 13:e1439. [PMID: 37830149 PMCID: PMC10570770 DOI: 10.1002/ctm2.1439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/15/2023] [Accepted: 10/01/2023] [Indexed: 10/14/2023] Open
Affiliation(s)
| | | | - Xuanyou Zhou
- Obstetrics and Gynecology HospitalInstitute of Reproduction and DevelopmentFudan UniversityShanghaiShanghaiP. R. China
| | - Tingyu Yang
- BGI‐ShenzhenShenzhenGuangdongP. R. China
- College of Life SciencesUniversity of Chinese Academy of SciencesBeijingBeijingP. R. China
| | - Mujin Ye
- International Peace Maternity and Child Health HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghaiShanghaiP. R. China
| | - Weihui Shi
- Obstetrics and Gynecology HospitalInstitute of Reproduction and DevelopmentFudan UniversityShanghaiShanghaiP. R. China
| | | | - Lanlan Zhang
- International Peace Maternity and Child Health HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghaiShanghaiP. R. China
| | - Qing Zhou
- BGI‐ShenzhenShenzhenGuangdongP. R. China
| | - Yulong Qin
- BGI‐ShenzhenShenzhenGuangdongP. R. China
- College of Life SciencesUniversity of Chinese Academy of SciencesBeijingBeijingP. R. China
| | - Yiyao Chen
- International Peace Maternity and Child Health HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghaiShanghaiP. R. China
| | - Fang Chen
- BGI‐ShenzhenShenzhenGuangdongP. R. China
| | - Hefeng Huang
- Obstetrics and Gynecology HospitalInstitute of Reproduction and DevelopmentFudan UniversityShanghaiShanghaiP. R. China
- International Peace Maternity and Child Health HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghaiShanghaiP. R. China
- Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences (No. 2019RU056)ShanghaiChina
| | - Songchang Chen
- Obstetrics and Gynecology HospitalInstitute of Reproduction and DevelopmentFudan UniversityShanghaiShanghaiP. R. China
| | - Chenming Xu
- Obstetrics and Gynecology HospitalInstitute of Reproduction and DevelopmentFudan UniversityShanghaiShanghaiP. R. China
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Abstract
Pruritus in pregnancy is a common and burdensome symptom that may be a first sign of a pregnancy-specific pruritic disease (atopic eruption of pregnancy, polymorphic eruption of pregnancy, pemphigoid gestationis, and intrahepatic cholestasis in pregnancy) or a dermatosis coinciding with pregnancy by chance. Despite its high prevalence, pruritus is often underrated by physicians, and data regarding the safety profiles of drugs for pruritus are very limited. In this review, we illustrate the epidemiology, possible pathophysiology, clinical characteristics, and diagnostic workup of various pregnancy-related diseases and discuss antipruritic treatments. The prevalence of pruritus in pregnancy demonstrates the importance of symptom recognition and the need for an holistic approach, taking into account both the potential benefits for the patient and the potential risks to the fetus.
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Affiliation(s)
- Aleksandra A Stefaniak
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Von Esmarch Str 58, 48149, Münster, Germany.
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland.
| | - Manuel P Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Von Esmarch Str 58, 48149, Münster, Germany
| | - Claudia Zeidler
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Von Esmarch Str 58, 48149, Münster, Germany
| | - Sonja Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Von Esmarch Str 58, 48149, Münster, Germany
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