Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy

Tetsuya Kawakita, Laura I. Parikh, Patrick S. Ramsey, Chun Chih Huang, Alexander Zeymo, Miguel Fernandez, Samuel Smith, Sara N. Iqbal

Research output: Contribution to journalArticle

Abstract

Objective We sought to determine predictors of adverse neonatal outcomes in women with intrahepatic cholestasis of pregnancy (ICP). Study Design This study was a multicenter retrospective cohort study of all women diagnosed with ICP across 5 hospital facilities from January 2009 through December 2014. Obstetric and neonatal complications were evaluated according to total bile acid (TBA) level. Multivariable logistic regression models were developed to evaluate predictors of composite neonatal outcome (neonatal intensive care unit admission, hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, transient tachypnea of the newborn, mechanical ventilation use, oxygen by nasal cannula, pneumonia, and stillbirth). Predictors including TBA level, hepatic transaminase level, gestational age at diagnosis, underlying liver disease, and use of ursodeoxycholic acid were evaluated. Results Of 233 women with ICP, 152 women had TBA levels 10-39.9 μmol/L, 55 had TBA 40-99.9 μmol/L, and 26 had TBA ≥100 μmol/L. There was no difference in maternal age, ethnicity, or prepregnancy body mass index according to TBA level. Increasing TBA level was associated with higher hepatic transaminase and total bilirubin level (P <.05). TBA levels ≥100 μmol/L were associated with increased risk of stillbirth (P <.01). Increasing TBA level was also associated with earlier gestational age at diagnosis (P <.01) and ursodeoxycholic acid use (P =.02). After adjusting for confounders, no predictors were associated with composite neonatal morbidity. TBA 40-99.9 μmol/L and TBA ≥100 μmol/L were associated with increased risk of meconium-stained amniotic fluid (adjusted odds ratio, 3.55; 95% confidence interval, 1.45-8.68 and adjusted odds ratio, 4.55; 95% confidence interval, 1.47-14.08, respectively). Conclusion In women with ICP, TBA level ≥100 μmol/L was associated with increased risk of stillbirth. TBA ≥40 μmol/L was associated with increased risk of meconium-stained amniotic fluid.

Original languageEnglish (US)
Pages (from-to)570.e1-570.e8
JournalAmerican journal of obstetrics and gynecology
Volume213
Issue number4
DOIs
StatePublished - Oct 1 2015
Externally publishedYes

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Bile Acids and Salts
Stillbirth
Ursodeoxycholic Acid
Meconium
Amniotic Fluid
Transaminases
Intrahepatic Cholestasis of Pregnancy
Gestational Age
Transient Tachypnea of the Newborn
Logistic Models
Odds Ratio
Confidence Intervals
Hyperbilirubinemia
Liver
Neonatal Intensive Care Units
Maternal Age
Bilirubin
Artificial Respiration
Hypoglycemia
Obstetrics

Keywords

  • bile acid
  • intrahepatic cholestasis of pregnancy
  • neonatal outcome
  • ursodeoxycholic acid

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Kawakita, T., Parikh, L. I., Ramsey, P. S., Huang, C. C., Zeymo, A., Fernandez, M., ... Iqbal, S. N. (2015). Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy. American journal of obstetrics and gynecology, 213(4), 570.e1-570.e8. https://doi.org/10.1016/j.ajog.2015.06.021

Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy. / Kawakita, Tetsuya; Parikh, Laura I.; Ramsey, Patrick S.; Huang, Chun Chih; Zeymo, Alexander; Fernandez, Miguel; Smith, Samuel; Iqbal, Sara N.

In: American journal of obstetrics and gynecology, Vol. 213, No. 4, 01.10.2015, p. 570.e1-570.e8.

Research output: Contribution to journalArticle

Kawakita, T, Parikh, LI, Ramsey, PS, Huang, CC, Zeymo, A, Fernandez, M, Smith, S & Iqbal, SN 2015, 'Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy', American journal of obstetrics and gynecology, vol. 213, no. 4, pp. 570.e1-570.e8. https://doi.org/10.1016/j.ajog.2015.06.021
Kawakita, Tetsuya ; Parikh, Laura I. ; Ramsey, Patrick S. ; Huang, Chun Chih ; Zeymo, Alexander ; Fernandez, Miguel ; Smith, Samuel ; Iqbal, Sara N. / Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy. In: American journal of obstetrics and gynecology. 2015 ; Vol. 213, No. 4. pp. 570.e1-570.e8.
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abstract = "Objective We sought to determine predictors of adverse neonatal outcomes in women with intrahepatic cholestasis of pregnancy (ICP). Study Design This study was a multicenter retrospective cohort study of all women diagnosed with ICP across 5 hospital facilities from January 2009 through December 2014. Obstetric and neonatal complications were evaluated according to total bile acid (TBA) level. Multivariable logistic regression models were developed to evaluate predictors of composite neonatal outcome (neonatal intensive care unit admission, hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, transient tachypnea of the newborn, mechanical ventilation use, oxygen by nasal cannula, pneumonia, and stillbirth). Predictors including TBA level, hepatic transaminase level, gestational age at diagnosis, underlying liver disease, and use of ursodeoxycholic acid were evaluated. Results Of 233 women with ICP, 152 women had TBA levels 10-39.9 μmol/L, 55 had TBA 40-99.9 μmol/L, and 26 had TBA ≥100 μmol/L. There was no difference in maternal age, ethnicity, or prepregnancy body mass index according to TBA level. Increasing TBA level was associated with higher hepatic transaminase and total bilirubin level (P <.05). TBA levels ≥100 μmol/L were associated with increased risk of stillbirth (P <.01). Increasing TBA level was also associated with earlier gestational age at diagnosis (P <.01) and ursodeoxycholic acid use (P =.02). After adjusting for confounders, no predictors were associated with composite neonatal morbidity. TBA 40-99.9 μmol/L and TBA ≥100 μmol/L were associated with increased risk of meconium-stained amniotic fluid (adjusted odds ratio, 3.55; 95{\%} confidence interval, 1.45-8.68 and adjusted odds ratio, 4.55; 95{\%} confidence interval, 1.47-14.08, respectively). Conclusion In women with ICP, TBA level ≥100 μmol/L was associated with increased risk of stillbirth. TBA ≥40 μmol/L was associated with increased risk of meconium-stained amniotic fluid.",
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AU - Parikh, Laura I.

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AU - Zeymo, Alexander

AU - Fernandez, Miguel

AU - Smith, Samuel

AU - Iqbal, Sara N.

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N2 - Objective We sought to determine predictors of adverse neonatal outcomes in women with intrahepatic cholestasis of pregnancy (ICP). Study Design This study was a multicenter retrospective cohort study of all women diagnosed with ICP across 5 hospital facilities from January 2009 through December 2014. Obstetric and neonatal complications were evaluated according to total bile acid (TBA) level. Multivariable logistic regression models were developed to evaluate predictors of composite neonatal outcome (neonatal intensive care unit admission, hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, transient tachypnea of the newborn, mechanical ventilation use, oxygen by nasal cannula, pneumonia, and stillbirth). Predictors including TBA level, hepatic transaminase level, gestational age at diagnosis, underlying liver disease, and use of ursodeoxycholic acid were evaluated. Results Of 233 women with ICP, 152 women had TBA levels 10-39.9 μmol/L, 55 had TBA 40-99.9 μmol/L, and 26 had TBA ≥100 μmol/L. There was no difference in maternal age, ethnicity, or prepregnancy body mass index according to TBA level. Increasing TBA level was associated with higher hepatic transaminase and total bilirubin level (P <.05). TBA levels ≥100 μmol/L were associated with increased risk of stillbirth (P <.01). Increasing TBA level was also associated with earlier gestational age at diagnosis (P <.01) and ursodeoxycholic acid use (P =.02). After adjusting for confounders, no predictors were associated with composite neonatal morbidity. TBA 40-99.9 μmol/L and TBA ≥100 μmol/L were associated with increased risk of meconium-stained amniotic fluid (adjusted odds ratio, 3.55; 95% confidence interval, 1.45-8.68 and adjusted odds ratio, 4.55; 95% confidence interval, 1.47-14.08, respectively). Conclusion In women with ICP, TBA level ≥100 μmol/L was associated with increased risk of stillbirth. TBA ≥40 μmol/L was associated with increased risk of meconium-stained amniotic fluid.

AB - Objective We sought to determine predictors of adverse neonatal outcomes in women with intrahepatic cholestasis of pregnancy (ICP). Study Design This study was a multicenter retrospective cohort study of all women diagnosed with ICP across 5 hospital facilities from January 2009 through December 2014. Obstetric and neonatal complications were evaluated according to total bile acid (TBA) level. Multivariable logistic regression models were developed to evaluate predictors of composite neonatal outcome (neonatal intensive care unit admission, hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, transient tachypnea of the newborn, mechanical ventilation use, oxygen by nasal cannula, pneumonia, and stillbirth). Predictors including TBA level, hepatic transaminase level, gestational age at diagnosis, underlying liver disease, and use of ursodeoxycholic acid were evaluated. Results Of 233 women with ICP, 152 women had TBA levels 10-39.9 μmol/L, 55 had TBA 40-99.9 μmol/L, and 26 had TBA ≥100 μmol/L. There was no difference in maternal age, ethnicity, or prepregnancy body mass index according to TBA level. Increasing TBA level was associated with higher hepatic transaminase and total bilirubin level (P <.05). TBA levels ≥100 μmol/L were associated with increased risk of stillbirth (P <.01). Increasing TBA level was also associated with earlier gestational age at diagnosis (P <.01) and ursodeoxycholic acid use (P =.02). After adjusting for confounders, no predictors were associated with composite neonatal morbidity. TBA 40-99.9 μmol/L and TBA ≥100 μmol/L were associated with increased risk of meconium-stained amniotic fluid (adjusted odds ratio, 3.55; 95% confidence interval, 1.45-8.68 and adjusted odds ratio, 4.55; 95% confidence interval, 1.47-14.08, respectively). Conclusion In women with ICP, TBA level ≥100 μmol/L was associated with increased risk of stillbirth. TBA ≥40 μmol/L was associated with increased risk of meconium-stained amniotic fluid.

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KW - intrahepatic cholestasis of pregnancy

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