Alanine aminotransferase as a predictor of adverse perinatal outcomes in women with intrahepatic cholestasis of pregnancy

Evaluation of alanine aminotransferase/aspartate aminotransferase ratio and high-density lipoprotein for predicting neonatal adverse outcomes associated with intrahepatic cholestasis of pregnancy

Background

To determine the association between lipid metabolism and intrahepatic cholestasis of pregnancy (ICP), and explore the value of maternal alanine aminotransferase/aspartate aminotransferase (ALT/AST) and high-density lipoprotein (HDL) in predicting adverse neonatal outcomes in women with ICP.

Methods

A total of 147 pregnant women with ICP admitted to The Fourth Hospital of Shijiazhuang and 120 normal pregnant women in the same period were selected in this study. The Mann-Whitney U test and Chi-square tests were used to compare the differences in clinical data. Multivariate logistic regression was used to analyze the relationship between ALT/AST and the occurrence of adverse pregnancy outcomes in patients with ICP. The combined predictive value of ALT/AST and HDL was determined by receiver operating characteristic (ROC) curve analysis.

Results

Among 147 women with ICP, 122 women had total bile acid (TBA) levels of 10-39.9 µmol/L, and 25 had TBA ≥ 40 µmol/L. There was significantly lower gestational age in patients with severe ICP than in those with mild and control groups (all p < 0.05), and the weight of newborns in the maternal ICP group was significantly lower than in the control group (p < 0.05). Increasing TBA levels was associated with higher AST, ALT, ALT/AST, and lower HDL level (all p < 0.05). Meanwhile, higher levels of ALT/AST was positively associated with neonatal hyperbilirubinemia [adjusted odds ratio (AOR) = 4.019, 95% CI [1.757-9.194, p = 0.001] and cardiac injury [AOR = 3.500, 95% CI [1.535-7.987], p = 0.003]. HDL was a significant protective factor for neonatal hyperbilirubinemia and cardiac injury [AOR = 0.315, 95% CI [0.126-0.788], p = 0.014; AOR = 0.134 (0.039-0.461), p = 0.001]. The area under the ROC curve (AUC) for prediction of neonatal hyperbilirubinemia by ALT/AST combined with HDL was 0.668 [95% CI [56.3-77.3%], p = 0.002], and the sensitivity and specificity were 47.1% and 84.0%, respectively. To predict neonatal cardiac injury, the AUC value was 0.668 [95% CI [56.4-77.1%], p = 0.002], with sensitivity and specificity were 41.2% and 87.1%, respectively.

Conclusions

The levels of higher ALT/AST and lower HDL were significantly associated with the risk of ICP-related adverse neonatal outcomes. Moreover, ALT/AST combined with HDL has moderate clinical value in predicting the adverse outcomes of neonatal hyperbilirubinemia and cardiac injury.

Predictors of Adverse Fetal Outcomes in Intrahepatic Cholestasis of Pregnancy (ICP): a Narrative Review

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.

Diagnostic and prognostic value of blood inflammation and biochemical indicators for intrahepatic cholestasis of pregnancy in Chinese pregnant women

Intrahepatic cholestasis of pregnancy (ICP) is a common liver disease during pregnancy, that has serious complications. This study aimed to compare the blood inflammation and biochemical markers of pregnant women with ICP in Southwest China and analyse their diagnostic value for ICP. A controlled cross-sectional study was conducted, and routine blood and biochemical indicators of 304 diagnosed ICP patients and 363 healthy pregnant women undergoing routine prenatal examination were assessed. The blood inflammatory indicators and biochemical indicators were compared between the ICP groups and normal groups. In this study, the levels of the ALT, AST, GGT, TBIL and DBIL biochemical indicators and the levels of WBC, neutrophils, NLR and PLR inflammatory indicators in the ICP group were significantly higher than those in healthy pregnant women (p < 0.001). The PA and lymphocytes of the ICP group were significantly lower than those of the normal group (p < 0.001). ROC curves showed that ALT and the NLR had higher predictive value for ICP. The GGT, TBA and NLR of pregnant women with ICP in the preterm group were significantly higher than those in the term group, and the combined NLR and TBA had a certain predictive value for preterm birth.

Intrahepatic Cholestasis of Pregnancy Is Associated with Reduced Nitric Oxide Synthase (iNOS) in Plasma and Placentas: A Pilot Study

Background

Intrahepatic cholestasis of pregnancy (ICP) is a condition specific to pregnancy, leading to increased fetal morbidity and mortality. Nitric oxide synthase (iNOS) may be a factor regulating the vasodilation of blood vessels, which are relevant to ischemic-hypoxic conditions. We aimed to explore the potential relationship between iNOS and ICP.

Material/Methods

A prospective, case-control study was conducted including 77 pregnant women with ICP and 80 healthy pregnant women as controls. Enzyme-linked immunosorbent assays were used to investigate maternal plasma iNOS levels. The placenta mRNA levels and cell-specific localization of iNOS were determined by quantitative polymerase chain reaction, western blotting, and immunohistochemical analysis. A multivariate linear regression model was used to identify the independent factors of serum total biliary acids (TAB) in ICP.

Results

Compared with controls, the expression of iNOS was significantly lower in maternal serum and placentas with ICP (P<0.001). Maternal plasm iNOS levels were negatively correlated with TAB (r=−0.450, P<0.001), cholyglycine (r=−0.367, P<0.001), alanine aminotransferase (r=−.359, P<0.001), and aspartate aminotransferase (r=−0.329, P<0.001). iNOS level was an indicator for ICP by multivariate linear regression analysis (β=−0.505, P<0.001). The ROC curve indicated the optimal cut-off level for iNOS was 2865.43 pg/mL (sensitivity, 85.71%; specificity, 63.75%). The ROC curve area for iNOS was 0.793 (95% CI 0.722–0.864).

Conclusions

iNOS plays an important role in poor fetoplacental vascular perfusion and adverse pregnancy outcomes. iNOS can provide complementary information in predicting the extent and severity of ICP.

Identifying risk effectors involved in neonatal hypoglycemia occurrence

Hypoglycemia is a common metabolic condition in neonatal period, but severe and persistent hypoglycemia can cause neurological damage and brain injury. The aim of the present study was to analyze the risk factors of neonatal hypoglycemia in clinic. A total of 135 neonatal hypoglycemia infants and 135 healthy infants were included in the present study. The differences in birth weight between neonatal hypoglycemia group and healthy control group were analyzed via t test. The associations between neonatal blood sugar level and relevant characteristic factors were explored using χ2 test. Binary logistic regression analysis was used to analyze risk factors related to the incidence of neonatal hypoglycemia. The results showed that the average birth weight was matched in neonatal hypoglycemia group and healthy control group. Neonatal blood sugar level of the infants was significantly associated with born term, birth weight, feed, gestational diabetes mellitus (GDM) and hypothermia (all P<0.05). Besides, logistic regression analysis showed that babies' born term (odds ratio (OR) = 2.715, 95% confidence interval (95% CI): 1.311-5.625), birth weight (OR = 1.910, 95% CI: 1.234-2.955), improper feeding (OR = 3.165, 95% CI: 1.295-7.736) and mother's GDM (OR = 2.184, 95% CI: 1.153-4.134) were high risk factors for neonatal hypoglycemia. The incidence of hypoglycemia in infants was significantly associated with various clinical factors. And monitoring these risk factors is one of important measures to reduce long-term neurological damage caused by neonatal hypoglycemia.

Clinical effects of evidence-based predictive nursing intervention in patients with intrahepatic cholestasis of pregnancy

AIM

To evaluate the clinical effects of evidence-based predictive nursing intervention in patients with intrahepatic cholestasis of pregnancy.

METHODS

One hundred and two patients with intrahepatic cholestasis of pregnancy treated at our hospital from July 2013 to March 2015 were randomly divided into a control group and an observation group. The control group received routine care, and the observation group patients received evidence-based predictive nursing intervention. After nursing care, serum levels of total bilirubin, bile acid, and alanine aminotransferase, pregnancy outcome, and patients'satisfaction to nursing care were compared between the two groups.

RESULTS

Serum levels of alanine transaminase, bile acids, and total bilirubin were significantly lower in the observation group than in the control group (P < 0.05). Neonatal weight, amniotic fluid contamination, neonatal asphyxia, and perinatal mortality were significantly better in the observation group than in the control group (P < 0.05). The rate of patients'satisfaction to nursing care was significantly higher in the observation group than in the control group (96.08% vs 68.63%, P < 0.05).

CONCLUSION

The clinical effects of evidence-based predictive nursing intervention for intrahepatic cholestasis of pregnancy are significant.