Abstract
Objective
Search for laboratory markers that can predict adverse fetal pregnancy
outcomes in patients with cholestasis of pregnancy.
Methods
This was an observational case-control study conducted from December 2016 to
December 2019. Pregnancy outcome data and maternal antenatal laboratory
markers were collected in the intrahepatic cholestasis of pregnancy (ICP)
(N=117) and normal pregnancy controls (N=100), laboratory indictors
including aspartate aminotransferase (AST), alanine aminotransferase (ALT),
alkaline phosphatase (ALP), γ-glutamyl transpeptidase (γ-GT), total
bilirubin (TB), direct bilirubin (DB), total bile acids (TBA), cholyglycine
(CG), prothrombin time (PT), international normalized ratio (INR), activated
partial thromboplastin time (APTT), fibrinogen (FIB), etc. The ICP group was
divided into an adverse outcome and normal outcome group according to fetal
pregnancy outcomes. Descriptive statistics and regression analysis were
performed on the prenatal indicators of the two groups to evaluate the
association between prenatal laboratory indicators in ICP patients and
adverse neonatal outcomes.
Results
ALT, TBA, CG, PT, APTT, hemoglobin, red blood cell distribution width,
hematocrit, mean platelet volume, and platelet distribution width in ICP
patients differed significantly from those in the normal control group,
which led to premature birth, amniotic fluid pollution, low birth weight and
other adverse outcomes. In terms of fetal outcomes, TBA [(39.16±35.70)
μmol/L vs. (24.17±18.76) μmol/L], CG [(22.17±19.42) μg/mL vs. ( 13.91±13.18)
μg/mL], DB [(22.17±19.42) μg/mL vs. (13.91±13.18) μg/mL] were higher than
those in the normal outcome group, while fibrinogen was lower [(4.16±1.30)
g/L vs. (4.78±0.91) g/L]; the difference was statistically significant.
Multivariate logistic regression analysis showed that CG(OR=1.06,
95%CI:1.01~1.12, P=0.02, FIB(OR=0.54, 95%CI:0.31~0.92, P=0.02) was
independently associated with the occurrence ofadverse fetal outcomes in
ICP.
Conclusions
Prenatal CG and FIB levels were independently associated with adverse fetal
outcomes in patients with ICP.
Keywords
adverse neonatal outcome - cholyglycine - fibrinogen - intrahepatic cholestasis of
pregnancy
