Article

Cholestasis of pregnancy.

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD, Room 203, Los Angeles, CA 90033, USA.
Obstetrics and Gynecology Clinics of North America (Impact Factor: 1.4). 06/2010; 37(2):269-82. DOI: 10.1016/j.ogc.2010.02.011
Source: PubMed

ABSTRACT Intrahepatic cholestasis (ICP) of pregnancy is a disease that is likely multifactorial in etiology and has a prevalence that varies by geography and ethnicity. The diagnosis is made when patients have a combination of pruritus and abnormal liver-function tests. It is associated with a high risk for adverse perinatal outcome, including preterm birth, meconium passage, and fetal death. As of yet, the cause for fetal death is unknown. Because fetal deaths caused by ICP appear to occur predominantly after 37 weeks, it is suggested to offer delivery at approximately 37 weeks. Ursodeoxycholic acid appears to be the most effective medication to improve maternal pruritus and liver-function tests; however, there is no medication to date that has been shown to reduce the risk for fetal death.

1 Bookmark
 · 
105 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective:To identify metabolic changes associated with early spontaneous preterm birth (PTB; <34 weeks) and term births, using high-throughput metabolomics of amniotic fluid (AF) in African American population.Method:In this study, AF samples retrieved from spontaneous PTB (<34 weeks [n = 25]) and normal term birth (n = 25) by transvaginal amniocentesis at the time of labor prior to delivery were subjected to metabolomics analysis. Equal volumes of samples were subjected to a standard solvent extraction method and analyzed using gas chromatography/mass spectrometry (MS) and liquid chromatography/MS/MS. Biochemicals were identified through matching of ion features to a library of biochemical standards. After log transformation and imputation of minimum observed values for each compound, t test, correlation tests, and false discovery rate corrections were used to identify differentially regulated metabolites. Data were controlled for clinical/demographic variables and medication during pregnancy.Results:Of 348 metabolites measured in AF samples, 121 metabolites had a gestational age effect and 116 differed significantly between PTB and term births. A majority of significantly altered metabolites could be classified into 3 categories, namely, (1) liver function, (2) fatty acid and coenzyme A (CoA) metabolism, and (3) histidine metabolism. The signature of altered liver function was apparent in many cytochrome P450-related pathways including bile acids, steroids, xanthines, heme, and phase II detoxification of xenobiotics with the largest fold change seen with pantothenol, a CoA synthesis inhibitor that was 8-fold more abundant in PTB.Conclusion:Global metabolic profiling of AF revealed alteration in hepatic metabolites involving xenobiotic detoxification and CoA metabolism in PTB. Maternal and/or fetal hepatic function differences may be developmentally related and its contribution PTB as a cause or effect of PTB is still unclear.
    Reproductive sciences (Thousand Oaks, Calif.) 01/2014; · 2.18 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction In this study, we aimed to investigate the relationship between neutrophil-to-lymphocyte ratio (NLR) and total bile acid (TBA) concentration in pregnant women with cholestasis of pregnancy (ICP). Materials and Methods Fasting and postprandial TBA, NLR, and aminotransferase (AST/ALT) levels in the blood samples of 65 pregnant women with intrahepatic cholestasis were examined in this prospective case–control study. Thirty-three of the patients had mild disease and 32 had severe disease; 70 healthy women in uncomplicated pregnancies served as the control group. Results Not only was the mean NLR elevated in the pregnant women with cholestasis when compared to the controls, but it also predicted the severity of the cholestasis. The correlation between fasting TBA and NLR was significant. Comments Altough TBA is still the diagnostic standard, NLR can be used as an initial screening tool due to its high specificty.
    European Journal of Obstetrics & Gynecology and Reproductive Biology 09/2014; · 1.63 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to describe maternal and fetal characteristics associated with intrahepatic cholestasis of pregnancy (ICP) and to determine clinical and biochemical predictors of fetal complications. A total of 89 singleton pregnancies with ICP were analysed, retrospectively. All data concerning laboratory results, symptom onset time, treatment response, delivery time and infant information were recorded in the study protocol. The mean gestational age at diagnosis was 32.6 ± 3.4 weeks; mean time of delivery was 36.8 ± 1.9 weeks. Binary logistic regression revealed that gestational age at diagnosis was predictive of preterm delivery (OR = 2.3, 95% CI: 1.5-3.3, p = 0.001). The incidence of respiratory distress syndrome (RDS), fetal growth restriction, fetal distress and preterm delivery were significantly higher in patients who were diagnosed before 30 weeks than after 34 weeks' gestation (p < 0.01). Gestational age at diagnosis is an important independent factor predicting adverse perinatal outcomes in patients with ICP.
    Journal of Obstetrics and Gynaecology 11/2014; · 0.60 Impact Factor