Role of inflammation in intrahepatic cholestasis of pregnancy

Biberoğlu, Ebru; Kırbaş, Ayşe; Dağlar, Korkut; Kara, Özgür; Karabulut, Erdem; Yakut, Halil İbrahim; Danışman, Nuri

doi:10.1111/jog.12902

Cited by 52 publications

(38 citation statements)

References 29 publications

(50 reference statements)

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“…Previous studies about ICP and inflammation suggested that ICP was an inflammatory process, and that perinatal outcomes were related to inflammation ( 18 , 31 , 32 , 33 ) . Bile acids are thought to be related to inflammation, and they directly affect hepatocytes and stimulate the secretion of proinflammatory mediators, which causes neutrophil accumulation, extravasation, and activation ( 17 ) .…”

Section: Discussionmentioning

confidence: 98%

Can we predict severity of intrahepatic cholestasis of pregnancy using inflammatory markers?

Abide

Vural

Kılıççı

et al. 2017

tjod

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Objective:To investigate the association of inflammatory markers with severity of intrahepatic cholestasis of pregnancy (ICP).Materials and Methods:This retrospective case-control study was conducted with 229 pregnant women, 84 with ICP, and 145 age-matched healthy pregnant women. Patients were categorized as mild ICP (<40 µmol/L) and severe ICP (≥40 µmol/L) with regard to serum bile acids. Inflammatory markers (neutrophil-to-lymphocyte ratio (NLR), platelet-to- lymphocyte ratio (PLR) and mean platelet volume (MPV), and red blood cell distribution width (RDW) were compared between the groups.Results:Patients with ICP had significantly decreased RDW and increased white blood cell counts (WBC), MPV and PLR, but no significant changes in NLR. The comparison of mild and severe cases with regard to NLR, PLR, WBC, and RDW was similar (p>0.05). MPV levels were significantly increased in severe group (p<0.05).Conclusion:WBC, MPV, and PLR were the inflammatory markers significantly increased, and RDW was signifantly reduced in ICP. MPV was the marker that significantly increased with the severity of disease. The use of inflammatory markers in the assessment of perinatal outcomes needs further studies.

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Section: Discussionmentioning

confidence: 98%

Can we predict severity of intrahepatic cholestasis of pregnancy using inflammatory markers?

Abide

Vural

Kılıççı

et al. 2017

tjod

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“…The mechanism by which ICP elevates the risk of SGA infants remains obscure. Several casecontrol studies showed that the levels of proinflammatory cytokines and chemokines in placenta and maternal serum were significantly higher in the cholestasis group as compared to the control group [31,32]. Reports in vivo and in vitro found that bile acids stimulated the expression of a series of inflammatory cytokines and chemokines via activating both signal 1 and 2 of the NLRP3 inflammasome and NF-κB pathway [33,34].…”

Section: Discussionmentioning

confidence: 99%

Elevated total bile acid levels during late pregnancy are associated with the risk of small-for-gestational-age infants

Chen

Qin

et al. 2019

Preprint

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Background Intrahepatic cholestasis of pregnancy (ICP) is common in pregnant women and is diagnosed by detecting serum total bile acid (TBA) levels. We aimed to investigate the association between serum total bile acid (TBA) levels during late pregnancy and the incidence of small-for-gestational-age (SGA) infants in a Chinese population.Methods The present study was a retrospective cohort study that included 11811 eligible mother-and-singleton-offspring pairs. The correlations between TBA levels and birth sizes, including birth weight, birth length, head circumference and chest circumference, were explored. The relative risk (RR) with 95%CI for SGA infants were estimated among subjects with ICP by multiple logistic regression analysis.Results Serum TBA levels were inversely linked with birth sizes. According to TBA levels, 11120 pregnant women were controls, 563 mild ICP, and 128 severe ICP. Birth sizes in ICP groups were lower than control group, and were the lowest in severe ICP group. Further analysis showed that 24.51% neonates were SGA infants among subjects with mild ICP (adjusted RR: 3.44; 95%CI: 2.72, 4.34) and 39.06% among subjects with severe ICP (adjusted RR: 6.54; 95%CI: 4.27, 10.02), higher than 7.39% among controls. For adjusted models, linear regression analysis showed that each 1μmol/L increase in TBA levels was associated with 11.1g (95%CI: -12.7, -9.5) decrease in birth weight, 0.045cm (95%CI: -0.053, -0.036) decrease in birth length, 0.034cm (95%CI: -0.040, -0.028) decrease in head circumference, and 0.041cm (95%CI: -0.047, -0.034) decrease in chest circumference, respectively.Conclusion Elevated TBA levels during late pregnancy are associated with an increased risk of SGA infants.

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“…12 The severity of ICP, especially in cases of bile acid levels exceeding 40 μmol/L, may affect pregnancy outcomes. 6,9 Based on these studies, we similarly classified cases with a bile acid level of ≥10-39 μmol/L and ≥40 μmol/L, as mild and severe ICP, respectively although a number of previous studies classified cases into three categories, mild, moderate and severe with BA levels of 10-39, 40-99 and >/100 µmol/L. In the present study, the rates of mild and severe ICP were 65.11%, and 34.89% respectively When comparing maternal characteristics, only difference found between the mild and severe cases was an earlier gestational age at delivery in the severe group and particularly an increase in the iatrogenic preterm deliveries.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5] The pathogenesis of ICP remains poorly understood: inflammatory, immunological and genetic influences contribute, as does pre-existing hepatobiliary disease. [6][7][8] ICP may be a challenge for health care providers because of the potential of severe fetal consequences, including prematurity and stillbirth. For the women, there are risks of recurrence and also of future hepatobiliary, cardiovascular and immunological diseases.…”

Section: Introductionmentioning

confidence: 99%

Intrahepatic cholestasis of pregnancy: maternal and fetal outcome and its correlation with serum bile acid levels

Sharma¹,

Arora²,

Dogra³

et al. 2018

Int J Reprod Contracept Obstet Gynecol

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Background: Maternal, fetal, and neonatal outcomes in parturients with intrahepatic cholestasis of pregnancy (ICP) have been retrospectively documented. We aimed to present pregnancy outcomes of parturients with ICP who underwent delivery. The study was conducted during a 1-year period in a tertiary care centre. Methods: Data from 1 January to 31 December 2017 were collected to identify parturients with ICP. Results: Almost 3/4th of births came to a vaginal delivery (76.74%) and only 10 parturients had cesarean delivery. 4 of 10 parturients underwent nonelective cesarean section, while 6 had elective cesarean delivery. 15.15 % vaginal deliveries were instrumental. The most common indications for emergency LSCS and instrumental deliveries was fetal distress followed by failure to progress of labour. Most births occurred at or after 37 weeks of gestation (65%). Regarding neonatal outcomes in terms of birth weight and Apgar scores at 1 and 5 min, they were positive, as well. None of the babies had Apgar score < 7 at 5 minutes. No case of perinatal death was observed. Conclusions: Although the results were generally positive, larger studies need to be conducted to evaluate the maternal and fetal outcomes in ICP and correlation with serum bile acid levels.

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Role of inflammation in intrahepatic cholestasis of pregnancy

Abstract: Interleukin-6 may have an essential role, apart from CRP, in the pathogenesis of ICP and, also, is a more sensitive marker of inflammation.

Cited by 52 publications

References 29 publications

Can we predict severity of intrahepatic cholestasis of pregnancy using inflammatory markers?

Can we predict severity of intrahepatic cholestasis of pregnancy using inflammatory markers?

Elevated total bile acid levels during late pregnancy are associated with the risk of small-for-gestational-age infants

Intrahepatic cholestasis of pregnancy: maternal and fetal outcome and its correlation with serum bile acid levels

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