MedStar Authors catalog › Details for: Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy.
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Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy.

by Kawakita, Tetsuya; Parikh, Laura I; Huang, Chun Chih; Zeymo, Alexander; Iqbal, Sara N.
Citation: American Journal of Obstetrics & Gynecology. 213(4):570.e1-8, 2015 Oct..Journal: American journal of obstetrics and gynecology.ISSN: 1097-6868.Full author list: Kawakita T; Parikh LI; Ramsey PS; Huang CC; Zeymo A; Fernandez M; Smith S; Iqbal SN.UI/PMID: 26071912.Subject(s): Adult | Alanine Transaminase/bl [Blood] | Aspartate Aminotransferases/bl [Blood] | Bile Acids and Salts/bl [Blood] | Cholagogues and Choleretics/tu [Therapeutic Use] | Cholestasis, Intrahepatic/bl [Blood] | Cholestasis, Intrahepatic/dt [Drug Therapy] | *Cholestasis, Intrahepatic/ep [Epidemiology] | Cohort Studies | Female | Gestational Age | Humans | *Hyperbilirubinemia/ep [Epidemiology] | *Hypoglycemia/ep [Epidemiology] | Infant, Newborn | Intensive Care Units, Neonatal/ut [Utilization] | Logistic Models | Multivariate Analysis | Oxygen Inhalation Therapy/ut [Utilization] | *Pneumonia/ep [Epidemiology] | Pregnancy | Pregnancy Complications/bl [Blood] | Pregnancy Complications/dt [Drug Therapy] | *Pregnancy Complications/ep [Epidemiology] | Pregnancy Outcome | Respiration, Artificial/ut [Utilization] | *Respiratory Distress Syndrome, Newborn/ep [Epidemiology] | Retrospective Studies | Risk Factors | *Stillbirth/ep [Epidemiology] | *Transient Tachypnea of the Newborn/ep [Epidemiology] | Ursodeoxycholic Acid/tu [Therapeutic Use] | Young AdultInstitution(s): MedStar Washington Hospital Center | MedStar Health Research InstituteDepartment(s): Obstetrics and Gynecology, Maternal-Fetal MedicineActivity type: Journal Article.Medline article type(s): Journal Article | Multicenter Study | Research Support, N.I.H., ExtramuralOnline resources: Click here to access online Digital Object Identifier: http://dx.doi.org/10.1016/j.ajog.2015.06.021 (Click here) Abbreviated citation: Am J Obstet Gynecol. 213(4):570.e1-8, 2015 Oct.Local Holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006.Abstract: OBJECTIVE: We sought to determine predictors of adverse neonatal outcomes in women with intrahepatic cholestasis of pregnancy (ICP).Abstract: 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.Abstract: RESULTS: Of 233 women with ICP, 152 women had TBA levels 10-39.9 mumol/L, 55 had TBA 40-99.9 mumol/L, and 26 had TBA >100 mumol/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 mumol/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 mumol/L and TBA >100 mumol/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).Abstract: CONCLUSION: In women with ICP, TBA level >100 mumol/L was associated with increased risk of stillbirth. TBA >40 mumol/L was associated with increased risk of meconium-stained amniotic fluid.Copyright � 2015 Elsevier Inc. All rights reserved.

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