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Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy.

MedStar author(s):

1097-6868

Name of journal: American journal of obstetrics and gynecologyAbstract: 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.OBJECTIVE: We sought to determine predictors of adverse neonatal outcomes in women with intrahepatic cholestasis of pregnancy (ICP).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).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.All authors: Fernandez M, Huang CC, Iqbal SN, Kawakita T, Parikh LI, Ramsey PS, Smith S, Zeymo ADigital Object Identifier:

http://dx.doi.org/10.1016/j.ajog.2015.06.021

Date added to catalog: 2016-01-15

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Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article		Available		26071912

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

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.

OBJECTIVE: We sought to determine predictors of adverse neonatal outcomes in women with intrahepatic cholestasis of pregnancy (ICP).

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).

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.

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