Maternal and neonatal outcomes of intrahepatic cholestasis of pregnancy and its influencing factors

Abstract

Objective To evaluate the relationship between mother and child prognosis and the total TBA and serum TBA in women with intrahepatic cholestasis of pregnancy (ICP) and to confirm the correlation of TBA level of women with ICP with fetal prognosis. Methods 256 women with ICP were selected from our hospital. According to the 2015 ICP guidelines of Chinese Medical Association, they were divided into a severe group (n=84) and a mild group (n=172). The levels of total bile acid, alanine aminotransferase, aspartate aminotransferase, γ-glutamyltransferase, alanine aminotransferase, and total bilirubin in the two groups were detected and compared. Logistic regression analysis was used to analyzed the correlation between TBA and maternal and child outcomes. Results The levels of total bile acid, alanine aminotransferase, aspartate aminotransferase, gamma-glutamine transaminase, and total bilirubin were significantly higher in the severe group than in the mild group, with statistical differences (all P < 0.001) . The gestational age was significantly shorter in the severe group than in the mild group, with a statistical difference (P=0.003). The incidence of Ⅲ degree amniotic fluid pollution significantly higher in the severe group than in the mild group [25 (29.8%) vs. 27 (15.7%)], with a statistical difference (P=0.009). The 1 and 5 min Apgar scores of the neonates in the severe group were significantly lower than those in the mild group (P = 0.025 and P = 0.049). More neonates were transferred to the department of pediatrics in the severe group than in the mild group [59 (73.8%) vs 85 (50.6%), P <0.001]. Multivariate analysis showed that the pregnant women’s level of TBA correlated with postpartum hemorrhage, premature rupture of membranes, neonatal myocardial damage, Ⅲ degree amniotic fluid pollution, premature birth, and fetal distress (P <0.05) but not with stillbirth risk (P= 0.226). Pearson correlation analysis showed that the final TBA level in prenatal women positively correlated with neonatal TBA (r=0.511, P=0.006). Conclusion TBA is the disease severity indicator and the disease diagnosis indicator and also predicts the fetuses’ prognosis. Key words: Intrahepatic cholestasis of pregnancy; Pregnant women; Maternal and neonatal outcomes