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Relationship between early onset severe intrahepatic cholestasis of pregnancy and higher risk of meconium-stained fluid

BACKGROUND: Intrahepatic cholestasis of pregnancy (ICP) is the commonest gestational liver disease. The risk of adverse fetal outcome has been associated with the severity of maternal hypercholanemia after diagnosis. OBJECTIVE: To investigate whether there is a relationship between the severity and...

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Autores principales: Estiú, Maria C., Frailuna, Maria A., Otero, Carla, Dericco, Marcela, Williamson, Catherine, Marin, Jose J. G., Macias, Rocio I. R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5402936/
https://www.ncbi.nlm.nih.gov/pubmed/28437442
http://dx.doi.org/10.1371/journal.pone.0176504
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author Estiú, Maria C.
Frailuna, Maria A.
Otero, Carla
Dericco, Marcela
Williamson, Catherine
Marin, Jose J. G.
Macias, Rocio I. R.
author_facet Estiú, Maria C.
Frailuna, Maria A.
Otero, Carla
Dericco, Marcela
Williamson, Catherine
Marin, Jose J. G.
Macias, Rocio I. R.
author_sort Estiú, Maria C.
collection PubMed
description BACKGROUND: Intrahepatic cholestasis of pregnancy (ICP) is the commonest gestational liver disease. The risk of adverse fetal outcome has been associated with the severity of maternal hypercholanemia after diagnosis. OBJECTIVE: To investigate whether there is a relationship between the severity and timing of onset of hypercholanemia and the risk of meconium-stained amniotic fluid (MSAF) and adverse neonatal events. STUDY DESIGN: The study included 382 pregnancies complicated by ICP managed at a referral hospital in Buenos Aires (Argentina) between June 2009 and December 2013. The patients were classified into three groups according to the severity of hypercholanemia at diagnosis; mild (10–19.9 μmol/L), moderate (20–39.9 μmol/L) and severe (≥40 μmol/L). Their clinical characteristics and pregnancy outcomes were investigated in a prospective observational study. RESULTS: Higher risk of MSAF was observed when ICP appeared early in gestation or when hypercholanemia was more severe. Taking both parameters into account an MSAF risk factor (MRF) was defined. Based on a model of positive/negative predictive values, a cut-off point of MRF = 3 was selected, which prioritized sensitivity versus specificity. In ICP patients with MRF>3, the probability of MSAF was enhanced 4-fold. An increase in the frequency of MSAF was also associated with higher serum levels at diagnosis of alanine transaminase, alkaline phosphatase and direct bilirubin. CONCLUSIONS: The risk of MSAF is associated not only with the magnitude of hypercholanemia at diagnosis but also with the early gestational onset of raised maternal serum bile acids.
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spelling pubmed-54029362017-05-12 Relationship between early onset severe intrahepatic cholestasis of pregnancy and higher risk of meconium-stained fluid Estiú, Maria C. Frailuna, Maria A. Otero, Carla Dericco, Marcela Williamson, Catherine Marin, Jose J. G. Macias, Rocio I. R. PLoS One Research Article BACKGROUND: Intrahepatic cholestasis of pregnancy (ICP) is the commonest gestational liver disease. The risk of adverse fetal outcome has been associated with the severity of maternal hypercholanemia after diagnosis. OBJECTIVE: To investigate whether there is a relationship between the severity and timing of onset of hypercholanemia and the risk of meconium-stained amniotic fluid (MSAF) and adverse neonatal events. STUDY DESIGN: The study included 382 pregnancies complicated by ICP managed at a referral hospital in Buenos Aires (Argentina) between June 2009 and December 2013. The patients were classified into three groups according to the severity of hypercholanemia at diagnosis; mild (10–19.9 μmol/L), moderate (20–39.9 μmol/L) and severe (≥40 μmol/L). Their clinical characteristics and pregnancy outcomes were investigated in a prospective observational study. RESULTS: Higher risk of MSAF was observed when ICP appeared early in gestation or when hypercholanemia was more severe. Taking both parameters into account an MSAF risk factor (MRF) was defined. Based on a model of positive/negative predictive values, a cut-off point of MRF = 3 was selected, which prioritized sensitivity versus specificity. In ICP patients with MRF>3, the probability of MSAF was enhanced 4-fold. An increase in the frequency of MSAF was also associated with higher serum levels at diagnosis of alanine transaminase, alkaline phosphatase and direct bilirubin. CONCLUSIONS: The risk of MSAF is associated not only with the magnitude of hypercholanemia at diagnosis but also with the early gestational onset of raised maternal serum bile acids. Public Library of Science 2017-04-24 /pmc/articles/PMC5402936/ /pubmed/28437442 http://dx.doi.org/10.1371/journal.pone.0176504 Text en © 2017 Estiú et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Estiú, Maria C.
Frailuna, Maria A.
Otero, Carla
Dericco, Marcela
Williamson, Catherine
Marin, Jose J. G.
Macias, Rocio I. R.
Relationship between early onset severe intrahepatic cholestasis of pregnancy and higher risk of meconium-stained fluid
title Relationship between early onset severe intrahepatic cholestasis of pregnancy and higher risk of meconium-stained fluid
title_full Relationship between early onset severe intrahepatic cholestasis of pregnancy and higher risk of meconium-stained fluid
title_fullStr Relationship between early onset severe intrahepatic cholestasis of pregnancy and higher risk of meconium-stained fluid
title_full_unstemmed Relationship between early onset severe intrahepatic cholestasis of pregnancy and higher risk of meconium-stained fluid
title_short Relationship between early onset severe intrahepatic cholestasis of pregnancy and higher risk of meconium-stained fluid
title_sort relationship between early onset severe intrahepatic cholestasis of pregnancy and higher risk of meconium-stained fluid
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5402936/
https://www.ncbi.nlm.nih.gov/pubmed/28437442
http://dx.doi.org/10.1371/journal.pone.0176504
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