Cholestasis Of Pregnancy Research Articles

Alterations in the Gut Microbiota in Chinese Patients With Intrahepatic Cholestasis of Pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy‐specific liver disease and the second most frequent cause of jaundice in pregnancy, but the etiology of it is poorly understood. By collecting blood and fecal samples from 12 healthy pregnant women (CON group) and 32 ICP patients (ICP group) in China, we performed 16s rRNA gene sequencing and analyzed microbial diversity. The results showed a decrease in species richness of the ICP group compared to that in the CON group, with a significant difference in species diversity between the two groups. Differential analysis revealed the following biomarkers: s__unclassified__Megamonas, g__Megamonas, f__Selenomonadaceae, c__Bacilli, and o__Lactobacillales. Importantly, we found a decrease in species richness of Selenomonadaceae at the family level and decreased bacilli at the class level in ICP patients. Correlation network analysis and functional gene prediction were performed accordingly. Our data provided new information linking microbiota and ICP, and are possibly helpful for further exploration of the disease.

Comprehensive analysis of jaundice in pregnancy: Evaluating maternal and fetal outcomes – A 3-year retrospective study in a tertiary care center

Background: Jaundice during pregnancy poses significant risks to both maternal and fetal health. This retrospective study aimed to assess the incidence, causes, and outcomes of jaundice among pregnant women admitted to a tertiary care center over a 3-year period. Aims and Objectives: The primary objectives were to identify the incidence of jaundice, analyze its causes, and evaluate the maternal and fetal outcomes in cases of jaundice during pregnancy. Materials and Methods: Conducted as a case series with clinical correlation, the study spanned 3 years (2021–2023) at the Department of Obstetrics and Gynecology, Kempegowda Institute of Medical Science, Bangalore. Data from parturition books and case sheets were collected after institutional ethical committee approval. Investigations included a complete blood count, liver function tests, coagulation profile, and serology. Fetal and maternal outcomes were recorded. Results: Out of 9 cases, 7 were diagnosed with intrahepatic cholestasis of pregnancy (IHCP), while 1 case each involved hemolysis, elevated liver enzymes, low platelet syndrome, and unconjugated hyperbilirubinemia specific to pregnancy. IHCP is correlated with adverse perinatal outcomes, including meconium-stained amniotic fluid and fetal distress. Cesarean sections were prevalent (58%), often indicated by previous lower segment cesarean sections and non-progression of labor. Conclusion: The study underscores the substantial association between IHCP and adverse perinatal outcomes, emphasizing the heightened prevalence of cesarean sections in pregnancies complicated by jaundice. It highlights the necessity for vigilant monitoring and tailored management strategies to mitigate risks and ensure favorable maternal and fetal outcomes in cases of jaundice during pregnancy.

Associations between ALDOB polymorphisms and intrahepatic cholestasis of pregnancy susceptibility in the Chinese Han population.

To research the associations between fructose-bisphosphate aldolase B (ALDOB) gene polymorphisms and intrahepatic cholestasis of pregnancy (ICP) risk. Whole-genome sequencing (WGS) was performed to detect ALDOB polymorphisms. Five web-available tools were employed to predict the effect of the site variant on the protein. Protein structure comparisons between the reference and ALDOB-modified samples were performed by SWISS-MODEL and Chimera 1.14rc, respectively. We identified 28 genetic variants in the ALDOB gene. When the cut-off value of minor allele frequency (MAF) of loci was 0.001 in four databases, five missense variants, including rs747604233, rs759204107, rs758242037, rs371526091 and rs77718928, were reserved for subsequent analysis. These variants were absent from the 1029 control individuals. The influence of all five variants on protein function was predicted to be damaging by the abovementioned five prediction software programs. Bioinformatics analysis demonstrated that these five missense variants were highly conserved among vertebrates. Compared to the wild-type protein structure, all five mutated protein structures showed a slight change in the chemical bond lengths of the enzyme activity domains. The combined clinical data indicate that the variant group had a significantly older age (p = 0.038), a higher level of indirect bilirubin (IDBIL, p = 0.033), and lower counts of white blood cells (WBCs, p = 7.38E-05) and platelets (PLTs, p = 0.018) than the wild-type group. This is the first study to examine the associations between ALDOB polymorphisms and ICP disease in 249 Chinese patients with ICP. Our present study expands the understanding of the pathogenesis of ICP.

Bile Acids – Friend or Foe? A Review of Pathological Significance and Therapeutic Potential

Bile acids have significant therapeutic and pathological interest in diagnostic and research-based investigations. This review describes the key processes involved in bile acid synthesis from cholesterol in addition to the conversion from primary to secondary bile acids. The normal physiological properties of bile acids are described, with particular focus on bile acids’ role as signalling molecules and their intra- and extra-hepatic circulation. The role of bile acids in pathology is also discussed, with particular emphasis on the role of bile acids in intrahepatic cholestasis of pregnancy. Measurement of bile acid concentration in the clinical laboratory is discussed in detail, including current methods of quantification. Finally, the role of exogenous bile acids is discussed to highlight how bile acids are utilised therapeutically and how they are being used in research settings for the delivery of various therapeutics. Overall, this review presents the dichotomy of bile acids as a pathological feature and a therapeutic interest in research.

Comparison of Obstetric Outcomes in Patients with Intrahepatic Cholestasis of Pregnancy Between Pregnancies Following In Vitro Fertilization and Spontaneous Conception: Four-Year Experience in a Tertiary Care Hospital

Comparison of Obstetric Outcomes in Patients with Intrahepatic Cholestasis of Pregnancy Between Pregnancies Following In Vitro Fertilization and Spontaneous Conception: Four-Year Experience in a Tertiary Care Hospital

Effectiveness Evaluation of a Graded Pharmaceutical Care Model in Women with Intrahepatic Cholestasis of Pregnancy: A Before‐After Study

Effectiveness Evaluation of a Graded Pharmaceutical Care Model in Women with Intrahepatic Cholestasis of Pregnancy: A Before‐After Study

İlk Trimesterde Monosit Sayısı ve Monosit Bazlı Kan Hücre İndekslerinin Gebeliğin İntrahepatik Kolestazı Gelişimi, Şiddeti ve Prognozunu Öngörmedeki Rolü

Abstract
 Aim: To evaluate the effect of monocyte count and monocyte-based whole blood cell indices in the prediction of intrahepatic cholestasis of pregnancy (ICP) in the first trimester.
 Materials and Method: The clinical data of patients who presented to the Perinatology Clinic of the Turkish Ministry of Health ----xxxxxxx--- ICP between January 1, 2021, and October 1, 2022, were evaluated retrospectively. Maternal demographic parameters, gestational age at birth, fetal birth weight, first-trimester white blood cell, neutrophil, platelet, monocyte, lymphocyte, and basophil counts, lymphocyte-to-monocyte ratio (LMR), platelet-to-monocyte ratio (PMR), neutrophil-to-monocyte ratio (NMR), and basophil-to-monocyte ratio (BMR) were recorded. These parameters were compared between the ICP and control groups. The relationship between monocyte count, monocyte-based blood cell indices, and fasting bile acid levels was evaluated in the ICP group. The cut-off values of the first-trimester monocyte count and monocyte-based blood cell indices for the prediction of ICP were determined.
 Results: Gestational week at birth and fetal birth weight were significantly lower, and the neonatal intensive care requirement was significantly higher in the ICP group (p

Evaluating the Utility of Liver Transaminases as Predictors of Feto-Maternal Outcome in Lieu of Serum Bile Acids in Intrahepatic Cholestasis of Pregnancy: A Prospective Observational Study.

Intrahepatic Cholestasis of Pregnancy (ICP) is a disorder of the second half of pregnancy causing pruritus and abnormal liver function tests (LFT). Incidence in India is 1.2-1.5%. ICP leads to adverse feto-maternal outcomes with early delivery indicated before serum bile acids (SBA) (gold standard) and hepatic transaminases are critically high. With paucity of evidence these levels are not well defined. To determine the association of liver transaminases with pregnancy outcomes in ICP and evaluate critical levels for prediction of adverse outcomes. A prospective observational study was conducted comprising 88 pregnant women with pruritus not associated with rash. After history and examination, LFT and SBA levels were done, treatment given and followed till pregnancy termination to determine the feto-maternal outcome. The mean age of participants was 26.43 ± 3.35 years. The mean SBA, ALT and AST levels were 18.97 ± 10.320 μmol/L, 206.06 ± 45.71units/litre and 175.37 ± 101.088 units/litre respectively. 39.7% of participants were symptomatic for ICP while 38.6% responded to treatment. 34.1% underwent LSCS majorly (43.3%) formeconiumand 23.3% had foetal distress. 33% had preterm delivery. 5.68% of the neonates needed NICU admission and 6.8% had respiratory distress syndrome. The cut off for ALT on ROC curve analysis was 151.5 units/litre with AUC as 0.905, sensitivity and specificity of 89.7 and 70% respectively. ICP leads to adverse pregnancy outcomes. ALT is a promising predictor of adverse outcome and termination of pregnancy can be planned accordingly.

COVID-stasis of Pregnancy: An Increased Prevalence of COVID-19 in Patients with Cholestasis.

To evaluate the relationship between intrahepatic cholestasis of pregnancy (ICP) and coronavirus disease 2019 (COVID-19). We performed a retrospective cohort study of pregnant women undergoing induction of labor (IOL) at a single institution between May 2020 to January 2021. Primary exposure was diagnosis of intrahepatic cholestasis of pregnancy (ICP). The primary outcome was the prevalence of COVID-19 as determined by reverse-transcriptase polymerase chain reaction testing on nasopharyngeal swabs for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) on routine admission testing. Secondary outcomes were abnormal laboratory values and adverse fetal outcomes. Logistic regression with log link analysis was performed comparing patients undergoing IOL for ICP compared with IOL for all other indications. The moderating effect of ethnicity was assessed by the interaction between ethnicity and ICP in a logistic regression model. The Wilcoxon rank-sum test and Fisher's exact test were performed for the secondary outcome analyses. Over the course of the study, 596 patients underwent IOL: 24 for ICP and 572 for other indications. The overall prevalence of COVID-19 positivity in the cohort was 5.5% (33 of 596). Those with ICP were more likely to test positive for COVID-19 compared with those with other IOL indications (29.2 vs. 4.5%, RR = 6.4, 95% CI: 2.8-12.5, p < 0.001). All patients with ICP who tested positive for COVID-19 were Hispanic. To analyze the moderating effect of ethnicity, the results of the logistic model found the interaction between ethnicity and ICP to not be significant (p = 0.991). In patients with ICP, the median AST (aspartate aminotransferase) was higher than those with COVID-19 (p = 0.0182). There were no adverse fetal outcomes in the ICP group. In this single-site retrospective cohort study, we demonstrated an increased prevalence of COVID-19 in those with ICP in general and among Hispanic patients specifically. Despite this difference, there was no increased risk of adverse fetal outcomes. · There is an increased prevalence of COVID-19 among Hispanic patients with ICP.. · The median AST of COVID-19-positive patients was significantly higher than COVID-19-negative patients.. · There was no increased risk of adverse fetal outcomes in with COVID-19 and ICP..

Cholestasis gravidarum in women in the second and third trimester of gestation, clinical and specific pharmacological treatment and its benefits

Introduction: cholestasis gravidarum is a syndrome that usually occurs in pregnant women in the second or third trimester of pregnancy and ends in the puerperium. It is clinically characterized by the presence of predominantly nocturnal pruritus that is palmoplantar at first and then generalized. Alterations in liver function with or without jaundice and elevated serum bile acid levels, biochemical cholestasis is classified as mild to moderate in severity.This pathology does not have significant consequences for the mother, but it is associated with a high risk of affecting the newborn, such as premature delivery, fetal distress, fetal arrhythmias and intrauterine death. Objective: diagnostic methods and behaviors in their pharmacological treatments that provide the best results for those patients. Methods: systematic review with qualitative database from the PUBMED platform. The articles were downloaded from the PUBMED platform and Zotero was used to make the proper citations and references. In the investigation, the population will be composed of adult female patients who were admitted to any health care unit during the second and third trimesters. Results: the PUBMED database was used with the following MESH terms (cholestasis of pregnancy) that generated 2 597 results. 28 articles were analyzed in more depth, of which 12 articles were finally selected for the final analysis. Ursodeoxycholic acid (UDCA), a beta epimer of chenodeoxycholic acid, is a more polar bile acid than primary bile acids, with substantial choleretic and multiple other chemoprotective effects. The mechanism of action is not fully understood, but studies have shown that after treatment there is a reduction in total serum bile acids in both maternal and umbilical cord serum and a qualitative change in bile acid pool. serum. When compared to all controls, UDCA was also found to be associated with a decreased incidence of preterm birth, neonatal respiratory distress, and the number of neonatal intensive care unit admissions

Chenodeoxycholic Acid Improves Embryo Implantation and Metabolic Health through Modulating Gut Microbiota-Host Metabolites Interaction during Early Pregnancy.

Fetus loss in early pregnancy is of major concern to both humans and animals, and this issue is largely influenced by embryo implantation. Chenodeoxycholic acid (CDCA), a primary bile acid, contributes to metabolic improvements and protects against intrahepatic cholestasis of pregnancy. However, the effect of CDCA on embryo implantation during early pregnancy has not been investigated. The present study demonstrated that CDCA administration during early pregnancy improved embryo implantation in sows and rats, thereby improving the pregnancy outcomes of sows. CDCA significantly reduced inflammation, oxidative stress, and insulin resistance. The metabolomics analysis indicated significant differences in the fecal metabolome, especially regarding the level of secondary bile acids, between the control and CDCA-treated sows. CDCA also influenced the serum metabolite profiles in sows, and the serum L-Histidine level was significantly correlated with the abundance of 19 differential fecal metabolites. Importantly, L-Histidine administration improved embryo implantation and metabolic health in rats during early pregnancy. Moreover, CDCA administration during early pregnancy also led to long-term metabolic improvements in sows. Our data indicated that CDCA improved embryo implantation by alleviating inflammation and oxidative stress, improving insulin sensitivity, and modulating the interaction between the gut microbiota and host metabolites. Therefore, CDCA intervention is a potential therapeutic strategy regarding embryo loss during pregnancy.

Serum placental growth factor, total cholesterol, and triglycerides for prediction of intrahepatic cholestasis of pregnancy.

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.

Serum Taurocholic Acid Levels Have Predictive Value for Adverse Maternal and Infant Outcomes in Pregnant Women with Intrahepatic Cholestasis of Pregnancy: A Prospective Cohort Study

Serum Taurocholic Acid Levels Have Predictive Value for Adverse Maternal and Infant Outcomes in Pregnant Women with Intrahepatic Cholestasis of Pregnancy: A Prospective Cohort Study

A chemical derivatization-based pseudotargeted liquid chromatography-tandem mass spectrometry method for sensitive and high coverage determination of bile acids in human serum

Global profiling of bile acids (BAs) is imperative for understand their function and disease pathogenesis. But it is still a challenging task, as the collision-induced dissociation (CID) fragment ions of unconjugated BAs showed low ion intensities to insufficient analysis. Herein, we developed a highly sensitive method for pseudotargeted profiling of BAs by chemical derivatization. In the developed method, a labeling reagent, 2-dimethylaminoethylamine (DMED), was adopted to label the carboxyl group of BAs. The results demonstrated that the detection sensitivities of unconjugated BAs were increased by 4–200 folds after DMED-labeling. Moreover, to profile other potential BAs not included in the 91 known targets, diverse survey experiments were performed on Qtrap-MS to search BAs for both precursor and fragment ion species, and retention index (RI) strategy was adopted to facilitate the identification of isomers. Finally, MRM-based LC-MS/MS method was validated for the pseudotargeted profiling of the BAs submetabolome with good linearity (r2 ≥ 0.990 for 89 known BAs) and high sensitivity (0.05–0.5 ng/mL for unconjugated BAs), covering unconjugated, glycine, taurine, sulfuric acid, glucuronic acid, and as well as those doubly-conjugated with above types. With this method, a total of 107 BAs, covering 54 BAs identified by authentic standards and 53 BAs candidates, were successfully determined in human serum of women with intrahepatic cholestasis of pregnancy (ICP). Multivariate analysis revealed deferentially expressed BAs. ICP disease altered the BAs profile with a reduced proportion of unconjugated, sulfate- and doubly-conjugated BAs and an increased proportion of glycine and taurine conjugates. Altered proportion and profile of BAs in ICP groups were gradually recovered during the ursodeoxycholic acid (UDCA) therapy. Overall, the strategy of DMED-labeling technique combined with diverse survey experiments is sufficiently sensitive and robust to comprehensively analysis of metabolic profiling of BAs in human serum.

MATERNAL AND FETAL OUTCOMES IN WOMEN RECEIVING URSODEOXYCHOLEIC ACID (UDCA) AS TREATMENT FOR INTRAHEPATIC CHOLESTASIS OF PREGNANCY (IHCP), A SINGLE CENTER EXPERIENCE: ARE WE DOING ENOUGH?

Intrahepatic cholestasis of pregnancy (IHCP) is a common type of hormonally driven cholestasis in the late second or early third trimester of pregnancy. It's a reversible condition and has a genetic predisposition. This study aimed to analyze the maternal and fetal outcomes of women being treated with Ursodeoxycholic acid (UDCA) for IHCP. Seventy-five pregnant women with IHCP were included in this observational cross-sectional study, with a study duration of one year. SPSS software version 24.0 was used to analyze the data collected by the investigating officer. Laboratory and clinical parameters were assessed at presentation and after treatment. Results showed that 92% of pregnant women with IHCP had significantly raised serum bile acid levels. However, UDCA treatment caused complete resolution of itching in 57.7% of patients, reduced to mild in 40.4%, and moderate itching in 1.9% of patients. Mean Alkaline Phosphatase and ALT levels significantly decreased after UDCA treatment, with p-values of 0.001 and 0.004, respectively. The dose of UDCA required ranged from 10-25 mg/kg/day. A positive family history of IHCP was found in 36.5% of patients, while 33% had a history of IHCP in previous pregnancies, and 16% had twin pregnancies. The incidence of early delivery was high at 98%, with a mean gestational age of 36.4 weeks. Among these early deliveries, 8% had vaginal delivery, and 92% had C-sections. The indications of delivery were intractable itching and no improvement in LFTS in 15%, PROM and fetal distress in 21%, failed induction in 31%, previous cesarean in 23%, and other reasons in 10%. The study found that 99% of babies had good APGAR scores and no morbidity. However, 1% mortality was reported due to severe IHCP in the mother. In conclusion, UDCA treatment significantly improved physical and laboratory parameters and effectively treated IHCP. Early delivery had better maternal and fetal outcomes.

Evaluation of liver functional test values in women with intrahepatic cholestasis of pregnancy

Introduction. Intrahepatic cholestasis of pregnancy is a liver disease, the diagnosis of which is based on the assessment of serum bile acid levels and liver function tests. The study aimed to assess liver function test values in women with intrahepatic cholestasis of pregnancy. Materials and methods. The study was based on a prospective cohort study of 142 clinical cases, divided into two groups according to the complication of pregnancy with cholestasis gravidarum. The research was carried out by assessing the level of liver function tests as well as by studying medical documentation. Statistical data were processed using IBM Statistics SPSS 21, MedCalc and GraphPad software. To assess sensitivity and specificity in examining model efficiency, the ROC curve was used. Results. Increased ALT and AST values were found in women with intrahepatic cholestasis of pregnancy. Alkaline phosphatase and γ-glutamyltransferase values were increased in an insignificant number of pregnant women with cholestasis gravidarum. Based on ROC curves, the sensitivity of ALT indicator in diagnosis of intrahepatic cholestasis of pregnancy was 81.7%, specificity - 81.7%; for AST the sensitivity of the indicator was 80.3%, specificity - 81.7%. Conclusions. In the study it was demonstrated significant increase of ALT and AST values in women with cholestasis gravidarum, as well as high sensitivity and specificity of these indicators in the diagnosis of intrahepatic cholestasis of pregnancy.

OBSTETRIC CHOLESTASIS IN FIRST TRIMESTER-UNUSUAL PRESENTATION OF THE DISEASE: CASE REPORT

Obstetric cholestasis (OC) presents mainly in the third trimester and uncommonly in the second trimester of pregnancy. It is characterised by pruritus, abnormal liver enzymes and raised total serum bile acids (TSBA). Cholestasis resolves after delivery. OC presenting in first trimester is rare, therefore the management guidelines are unclear. The present case is being reported as a case of first trimester OC, unresponsive to common treatment modalities. The patient was diagnosed with OC at 12 weeks. She didn't respond to the therapeutic doses of ursodeoxycholic acid (UDCA) and cholestyramine. Finally, rifampicin was added, which gave clinical relief, improved liver enzyme levels and allowed the pregnancy to continue till 32 weeks.

Fetal PR Interval in Pregnancies with Intrahepatic Cholestasis of Pregnancy: A Case-Control Study.

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). 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. 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). 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. · 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..

Intrahepatic cholestasis of pregnancy is associated with increased risk of hepatobiliary disease and adverse fetal outcomes: A systematic review and meta-analysis

Background and aimsThe aim of this study was to review the literature and perform a meta-analysis to clarify the association between intrahepatic cholestasis of pregnancy and risks of long-term maternal hepatobiliary disease as well as adverse fetal outcomes including preterm birth, meconium-stained amniotic fluid, and stillbirth. MethodsThis systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search was performed using Cochrane, Embase, and PubMed databases to identify observational or cohort studies comparing pregnant women with intrahepatic cholestasis of pregnancy (ICP) to pregnant women without ICP. Data from the included studies were analyzed using the Review Manager 5.4.1 software. ResultsThe meta-analysis showed a significant association between ICP and the risk of hepatobiliary diseases (pooled risk ratio [RR]: 2.81, 95% confidence interval [CI]: 2.66–2.97, p < 0.00001), hepatitis C (HC): a significant association between ICP and risk of HC (pooled RR: 4.02, 95% CI: 3.12–5.19, p < 0.00001), meconium-stained amniotic fluid (MSAF): ICP was significantly associated with an increased risk of MSAF (pooled RR: 1.91, 95% CI: 1.65–2.21, p < 0.00001), and preterm birth: the meta-analysis demonstrated a significant association between ICP and preterm birth (pooled RR: 2.11, 95% CI: 2.01–2.21, p < 0.00001). ConclusionICP demonstrated statistically significant associations with increased risks of hepatobiliary disease, HC, MSAF, and preterm birth.

Intrahepatic cholestasis of pregnancy: insights into pathogenesis and advances in omics studies.

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.