Predicting Fetal Asphyxia in Intrahepatic Cholestasis of Pregnancy

Abstract

Intrahepatic cholestasis of pregnancy (ICP) is associated with significant perinatal morbidity and mortality. ICP-related prenatal complications include increased premature delivery, fetal distress, perinatal asphyxia, and intrauterine fetal loss. Levels of serum total bile acids (TBA) are typically elevated from 10- to 100-fold and may be used as a diagnostic criterion for ICP. An association between ICP and respiratory distress syndrome has been reported, and it has been suggested that scoring systems that include TBA level and exposure time may be useful to predict respiratory distress syndrome in neonates. This retrospective study investigated biochemical parameters that could be useful as potential predictors of fetal asphyxia in patients with ICP. The study was conducted between 2004 and 2008 at a tertiary care maternity center. A total of 187 cholestatic pregnancies in both primiparous (43; 23%) and multiparous (144; 77%) women were included in the study. Fetal asphyxia was defined as a mean 5 Apgar score of less than 7. A binary multivariate logistic regression model was used to identify independent variables that may help predict fetal asphyxia in ICP. Of the 187 cholestatic pregnancies, 36 (19.2%) resulted in asphyctic newborns at delivery. There were statistically significant differences between the asphyxiated and nonasphyxiated group in levels of TBA (42.4 ± 15.2 vs. 33.8 ± 12.9 μmol/L, P < 0.01), total cholesterol (279.0 ± 51.4 vs. 257.7 ± 51.6, P = 0.02), high-density lipoprotein (54.2 ± 15.9 vs. 61.3 ± 12.2, P = 0.01), and triacylglycerol (299.4 ± 94.6 vs. 260.4 ± 118.7, P = 0.03). In the multivariate model, independent variables that significantly predicted fetal asphyxia in ICP were TBA levels (odds ratio, 1.04; 95% confidence interval, 1.01–1.08, P = 0.03) and exposure time (odds ratio, 1.11; 95% confidence interval, 1.05–1.17, P < 0.01). These findings suggest that the most important predictive factors for fetal asphyxia in ICP are levels of TBA and exposure time.