TY - JOUR
T1 - Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy
AU - Kawakita, Tetsuya
AU - Parikh, Laura I.
AU - Ramsey, Patrick S.
AU - Huang, Chun Chih
AU - Zeymo, Alexander
AU - Fernandez, Miguel
AU - Smith, Samuel
AU - Iqbal, Sara N.
N1 - Funding Information:
This project was funded in part with grant number UL1TR000101 (previously UL1RR031975) from the National Center for Advancing Translational Sciences , National Institutes of Health , through the Clinical and Translational Science Awards Program, a trademark of the Department of Health and Human Services, part of the Roadmap Initiative, “Re-Engineering the Clinical Research Enterprise.”
Publisher Copyright:
© 2015 Elsevier Inc.
PY - 2015/10/1
Y1 - 2015/10/1
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.
KW - bile acid
KW - intrahepatic cholestasis of pregnancy
KW - neonatal outcome
KW - ursodeoxycholic acid
UR - http://www.scopus.com/inward/record.url?scp=84942296545&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84942296545&partnerID=8YFLogxK
U2 - 10.1016/j.ajog.2015.06.021
DO - 10.1016/j.ajog.2015.06.021
M3 - Article
C2 - 26071912
AN - SCOPUS:84942296545
SN - 0002-9378
VL - 213
SP - 570.e1-570.e8
JO - American journal of obstetrics and gynecology
JF - American journal of obstetrics and gynecology
IS - 4
ER -