Total serum bile acids or serum bile acid profile, or both, for the diagnosis of intrahepatic cholestasis of pregnancy

Manzotti, Cristina; Casazza, Giovanni; Štimac, Tea; Nikolova, Dimitrinka; Gluud, Christian

doi:10.1002/14651858.cd012546

Cited by 7 publications

(7 citation statements)

References 61 publications

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“…TBA is a class of cholesterol metabolites seen in hepatic catabolism and enterohepatic circulation. It is a byproduct of cholesterol breakdown in the liver, and it is linked to cholesterol absorption and physiological metabolism processes [ 18 ]. Therefore, TBA is another one of ICP's diagnostic indications.…”

Section: Discussionmentioning

confidence: 99%

Value of Serum Glycocholic Acid and Total Bile Acids in Predicting Maternal and Perinatal Outcomes in Intrahepatic Cholestasis of Pregnancy

2021

Journal of Healthcare Engineering

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Objective. To see whether serum glycocholic acid (CG) and total bile acids (TBA) can predict maternal and perinatal outcomes in pregnant women with intrahepatic cholestasis (ICP). Method. The observation group consisted of 80 women with ICP who were treated in our hospital, whereas the control group consisted of 50 ordinary women who were also treated at our hospital at the same time. The levels of CG and TBA in the two groups were determined independently, and the differences in poor perinatal outcomes were compared. Finally, the predictive diagnostic value of CG and TBA for poor perinatal outcomes in ICP mothers was displayed using the Spearman correlation between CG and TBA and Apgar. The maternal CG and TBA levels in the observation group were substantially higher than in the control group (P0.05). The observation group had more significant maternal-fetal discomfort, neonatal asphyxia, preterm birth, and perinatal death than the control group (P0.05). The risk of poor perinatal outcomes in ICP mothers rose when TBA and CG levels increased (P0.05). Apgar ratings were inversely associated with CG and TBA (r = −0.8251 and r = −0.5969, respectively, P0.05). The CG and TBA diagnostic AUCs for unfavorable perinatal outcomes in ICP mothers were (P0.05). Conclusion. CG and TBA have a high diagnostic value for ICP and may better predict and identify poor prenatal outcomes. It is suitable for clinical use.

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Section: Discussionmentioning

confidence: 99%

Value of Serum Glycocholic Acid and Total Bile Acids in Predicting Maternal and Perinatal Outcomes in Intrahepatic Cholestasis of Pregnancy

2021

Journal of Healthcare Engineering

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“…A total serum bile acid level of >10 mmol/L is often used to diagnose ICP, although the data are limited and the diagnostic accuracy has been questioned. 6,7 Increases in the levels of transaminases (eg, alanine aminotransferase and aspartate aminotransferase) can also sometimes be seen in ICP, although elevated transaminase levels are not necessary for the diagnosis. Although the bile acid level can be affected by a postprandial state 8 and fasting bile acid measurements are often performed, the differences between the random and fasting results are small.…”

Section: What Is the Differential Diagnosis Of Pruritus In Pregnancy?mentioning

confidence: 99%

Society for Maternal-Fetal Medicine Consult Series #53: Intrahepatic cholestasis of pregnancy

Lee

Greenberg

Metz

et al. 2021

American Journal of Obstetrics and Gynecology

107

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ACOG) endorses this document.Intrahepatic cholestasis of pregnancy is a hepatic disorder characterized by pruritus and an elevation in serum bile acid levels. Although intrahepatic cholestasis of pregnancy poses little risk for women, this condition carries a significant risk for the fetus, including complications such as preterm delivery, meconium-stained amniotic fluid, and stillbirth. The purpose of this Consult is to review the current literature on intrahepatic cholestasis of pregnancy and provide recommendations based on the available evidence. The recommendations by the Society for Maternal-Fetal Medicine are as follows: (1) we recommend measurement of serum bile acid and liver transaminase levels in patients with suspected intrahepatic cholestasis of pregnancy (GRADE 1B); (2) we recommend that ursodeoxycholic acid be used as the first-line agent for the treatment of maternal symptoms of intrahepatic cholestasis of pregnancy (GRADE 1A); (3) we suggest that patients with a diagnosis of intrahepatic cholestasis of pregnancy begin antenatal fetal surveillance at a gestational age when delivery would be performed in response to abnormal fetal testing results or at the time of diagnosis if the diagnosis is made later in gestation (GRADE 2C); (4) we recommend that patients with total bile acid levels of 100 mmol/L be offered delivery at 36 0/7 weeks of gestation, given that the risk of stillbirth increases substantially around this gestational age (GRADE 1B); (5) we recommend delivery between 36 0/7 and 39 0/7 weeks of gestation for patients with intrahepatic cholestasis of pregnancy and total bile acid levels of <100 mmol/L (GRADE 1C); (6) we recommend administration of antenatal corticosteroids for fetal lung maturity for patients delivering before 37 0/7 weeks of gestation if not previously administered (GRADE 1A); (7) we recommend against preterm delivery at <37 weeks of gestation in patients with a clinical diagnosis of intrahepatic cholestasis of pregnancy without laboratory confirmation of elevated bile acid levels (GRADE 1B).

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“…9 A systematic review published in 2019 stated that a cut off value of 10umol/L for TBA had an overall sensitivity ranging from 72% to 98% and specificity ranging from 81% to 97%. 21 A retrospective study conducted in China revealed that pregnant females had increased fasting serum bile acid levels even without the presence of symptoms and these asymptomatic pregnant females had similar or a higher risk of still birth than patients with ICP. 22 Demir along with his colleagues while establishing relationship between Serum Bile Acid levels and maternal and fetal outcomes found that mean TBA level in preterm birth group was significantly higher as compared to the term birth group.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Significance of Serum Total Bile Acid Levels in Suspected Cases of Obstetric Cholestasis

Batool¹

2020

Proceedings

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Introduction: Intrahepatic Cholestasis of Pregnancy (ICP) is significantly associated with adverse maternal and fetal outcome and therefore accurate diagnosis and timely initiation of therapy is of utmost importance. Aims & Objectives: To find out the diagnostic significance of serum total bile acid measurement in suspected cases of obstetric cholestasis. Place and duration of study: It was a cross sectional study conducted in the Department of Clinical Chemistry and Immunology, Chughtai Institute of Pathology from July 2018 to February 2019. Material & Methods: Two hundred pregnant females whose serum total bile acid (TBA) was determined were included in the study. Pregnant females with cholestasis due to medical reasons other than ICP were excluded from the study. The patients were contacted for relevant clinical details which were recorded on a pre-designed proforma. Data was analyzed using SPSS 23.0. Univariate analysis was done to find out percentages and frequencies. Results: Mean age of 200 pregnant females was 27 years having Mean TBA value of 32.8 ?mol/L. 63% females were primiparous. 197 (98.5%) patients gave the history of pruritus while 193 (96.5%) patients presented with dark urine. Only 30 patients (15%) gave history of using progesterone during pregnancy. Total Bile acid value was >10 ?mol/L for 84 primiparous and 48 multiparous cases (n=132). There was no significant difference in the mean TBA value on the basis of parity, medication, mode of delivery or presence and absence of itch. Conclusion: ICP is a multi factorial reversible condition and bile acid estimation plays a major role in correct clinical assessment of patients with obstetric cholestasis.

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Total serum bile acids or serum bile acid profile, or both, for the diagnosis of intrahepatic cholestasis of pregnancy

Abstract: Total serum bile acids or serum bile acid profile, or both, for the diagnosis of intrahepatic cholestasis of pregnancy.

Cited by 7 publications

References 61 publications

Value of Serum Glycocholic Acid and Total Bile Acids in Predicting Maternal and Perinatal Outcomes in Intrahepatic Cholestasis of Pregnancy

Value of Serum Glycocholic Acid and Total Bile Acids in Predicting Maternal and Perinatal Outcomes in Intrahepatic Cholestasis of Pregnancy

Society for Maternal-Fetal Medicine Consult Series #53: Intrahepatic cholestasis of pregnancy

Diagnostic Significance of Serum Total Bile Acid Levels in Suspected Cases of Obstetric Cholestasis

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