TY  - BOOK
AU  - Huang, Chun Chih
AU  - Iqbal, Sara N
AU  - Kawakita, Tetsuya
AU  - Parikh, Laura I
AU  - Zeymo, Alexander
TI  - Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy
SN  - 1097-6868
KW  - *Cholestasis, Intrahepatic/ep [Epidemiology]
KW  - *Hyperbilirubinemia/ep [Epidemiology]
KW  - *Hypoglycemia/ep [Epidemiology]
KW  - *Pneumonia/ep [Epidemiology]
KW  - *Pregnancy Complications/ep [Epidemiology]
KW  - *Respiratory Distress Syndrome, Newborn/ep [Epidemiology]
KW  - *Stillbirth/ep [Epidemiology]
KW  - *Transient Tachypnea of the Newborn/ep [Epidemiology]
KW  - Adult
KW  - Alanine Transaminase/bl [Blood]
KW  - Aspartate Aminotransferases/bl [Blood]
KW  - Bile Acids and Salts/bl [Blood]
KW  - Cholagogues and Choleretics/tu [Therapeutic Use]
KW  - Cholestasis, Intrahepatic/bl [Blood]
KW  - Cholestasis, Intrahepatic/dt [Drug Therapy]
KW  - Cohort Studies
KW  - Female
KW  - Gestational Age
KW  - Humans
KW  - Infant, Newborn
KW  - Intensive Care Units, Neonatal/ut [Utilization]
KW  - Logistic Models
KW  - Multivariate Analysis
KW  - Oxygen Inhalation Therapy/ut [Utilization]
KW  - Pregnancy
KW  - Pregnancy Complications/bl [Blood]
KW  - Pregnancy Complications/dt [Drug Therapy]
KW  - Pregnancy Outcome
KW  - Respiration, Artificial/ut [Utilization]
KW  - Retrospective Studies
KW  - Risk Factors
KW  - Ursodeoxycholic Acid/tu [Therapeutic Use]
KW  - Young Adult
KW  - MedStar Health Research Institute
KW  - MedStar Washington Hospital Center
KW  - Obstetrics and Gynecology, Maternal-Fetal Medicine
KW  - Journal Article
KW  - Multicenter Study
KW  - Research Support, N.I.H., Extramural
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
N2  - 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
UR  - http://dx.doi.org/10.1016/j.ajog.2015.06.021
ER  -