Early Detection of Intrahepatic Cholestasis of Pregnancy: Correlation Between Liver Enzymes and Adverse Fetal Outcomes
Main Article Content
Abstract
Background: Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder that occurs in late pregnancy and leads to elevated bile acid levels in the maternal serum, posing risks to fetal health, including preterm labor and fetal distress. Understanding the relationships between liver enzyme levels and fetal outcomes can guide early diagnostic and management strategies.
Objective: To evaluate the significance of early detection of ICP through routine liver enzyme tests (AST and ALT) and its correlation with adverse fetal outcomes to inform clinical practices in regions with limited access to advanced diagnostic tools.
Methods: This cross-sectional study was conducted at the Ittefaq Hospital Trust, Lahore, involving 90 pregnant women categorized into three groups based on gestational age and ICP symptoms. Group A consisted of 30 women at 30-34 weeks of gestation, Group B included 30 women at 34-37 weeks, and Group C comprised 30 healthy pregnant women as controls. Serum AST and ALT levels were measured at day 0, 30, and 45. Fetal outcomes were monitored through ultrasound and medical records. Statistical analysis was performed using SPSS version 25, employing descriptive statistics and ANOVA to compare enzyme levels and fetal outcomes across groups.
Results: Group 2 exhibited significantly higher mean AST levels (96.58 U/L) and ALT levels (183.10 U/L) compared to Group 1 (AST: 49.95 U/L, ALT: 100.90 U/L) and Group 3 (AST: 25.30 U/L, ALT: 35.05 U/L). Adverse fetal outcomes, including intrauterine growth restriction (IUGR), were notably higher in Group 2 (76.7%) compared to Group 1 (13.33%) and Group 3 (0%). The statistical significance was marked with a p-value < 0.05 across all comparisons.
Conclusion: Elevated liver enzymes, specifically AST and ALT, are strongly associated with adverse fetal outcomes in ICP. Early detection and monitoring of these enzymes can be crucial in preventing fetal complications, particularly in resource-limited settings where traditional diagnostic measures are inaccessible.
Article Details
![Creative Commons License](http://i.creativecommons.org/l/by/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Walker KF, Chappell LC, Hague WM, Middleton P, Thornton JG. Pharmacological Interventions for Treating Intrahepatic Cholestasis of Pregnancy. Cochrane Database Syst Rev. 2020 Jul 7;(7). doi: 10.1002/14651858.CD000493.pub3.
Geenes V, Chappell LC, Seed PT, Steer PJ, Knight M, Williamson C. Association of Severe Intrahepatic Cholestasis of Pregnancy with Adverse Pregnancy Outcomes: A Prospective Population‐Based Case‐Control Study. Hepatology. 2014 Apr;59(4):1482-1491. doi: 10.1002/hep.26755.
Ismael A, Kennedy L, Francis H. Sex-Dependent Differences in Cholestasis: Why Estrogen Signaling May Be a Key Pathophysiological Driver. Am J Pathol. 2023 Feb;193(2):354-366. doi: 10.1016/j.ajpath.2022.11.007.
Zhang X, Chen Y, Salerno S, Li Y, Zhou L, Zeng X, Li H. Prediction of intrahepatic cholestasis of pregnancy in the first 20 weeks of pregnancy. The Journal of Maternal-Fetal & Neonatal Medicine. 2022 Dec 12;35(25):6329-35.
Piechota J, Jelski W. Intrahepatic cholestasis in pregnancy: review of the literature. Journal of Clinical Medicine. 2020 May 6;9(5):1361.
Hingankar Y, Taksande V. Intra-Hepatic Cholestasis of Pregnancy and Its Consequences: A Review. Journal of Pharmaceutical Research International. 2021 Dec 14:224-30.
Sitaula D, Timalsina S, Sharma B, Pokharel B, Thapa R. Prevalence and pregnancy outcomes of intrahepatic cholestasis of pregnancy. 2017 Nov 13:2-8.
Mathur D, Morgan M, McKenzie J, Wakefield D, Janicki MB, Figueroa R. Intrahepatic cholestasis of pregnancy: dilemma in diagnosis and management. The Journal of Maternal-Fetal & Neonatal Medicine. 2022 Dec 12;35(25):8975-81.
Mashburn S, Schleckman E, Cackovic P, Shellhaas C, Rood KM, Ma’ayeh M. Intrahepatic cholestasis of pregnancy: risk factors for severe disease. The Journal of Maternal-Fetal & Neonatal Medicine. 2022 Dec 12;35(25):8566-70.
Uzel K, Bilir F, Astepe BS, Uluğ P, Arslan YK, Kiremitli T. Intrahepatic Cholestasis of Pregnancy and Maternal-Fetal Results. Online Turkish Journal of Health Sciences. 2022 Jan 3;7(1):68-73.
Mor M, Shmueli A, Krispin E, Bardin R, Sneh-Arbib O, Braun M, Arbib N, Hadar E. Intrahepatic cholestasis of pregnancy as a risk factor for preeclampsia. Archives of gynecology and obstetrics. 2020 Mar;301:655-64.
Obiegbusi CN, Dong XJ, Obiegbusi SC. Pregnancy outcomes following antenatal screening for intrahepatic cholestasis of pregnancy (ICP). Taiwanese Journal of Obstetrics and Gynecology. 2023 Nov 1;62(6):809-16.
Majsterek M, Wierzchowska-Opoka M, Makosz I, Kreczyńska L, Kimber-Trojnar Ż, Leszczyńska-Gorzelak B. Bile acids in intrahepatic cholestasis of pregnancy. Diagnostics. 2022 Nov 9;12(11):2746.
Chen Y, Zhang H, Ning W, Chen Y, Wen C. The impact of intrahepatic cholestasis on pregnancy outcomes: a retrospective cohort study. BMC gastroenterology. 2023 Jan 18;23(1):16.
Gao XX, Ye MY, Liu Y, Li JY, Li L, Chen W, Lu X, Nie G, Chen YH. Prevalence and risk factors of intrahepatic cholestasis of pregnancy in a Chinese population. Scientific reports. 2020 Oct 1;10(1):16307.
Girling J, Knight CL, Chappell L. Intrahepatic cholestasis of pregnancy: Green‐top Guideline No. 43 June 2022. BJOG: An International Journal of Obstetrics & Gynaecology. 2022 Dec 1;129(13).
Liu C, Gao J, Liu J, Wang X, He J, Sun J, Liu X, Liao S. Intrahepatic cholestasis of pregnancy is associated with an increased risk of gestational diabetes and preeclampsia. Annals of translational medicine. 2020 Dec;8(23).
Sahni A, Jogdand SD. Effects of intrahepatic cholestasis on the foetus during pregnancy. Cureus. 2022 Oct 25;14(10).
Monrose E, Bui A, Rosenbluth E, Dickstein D, Acheampong D, Sigel K, Ferrara L, Kushner T. Burden of future liver abnormalities in patients with intrahepatic cholestasis of pregnancy. Official journal of the American College of Gastroenterology| ACG. 2021 Mar 1;116(3):568-75.
Dong R, Ye N, Zhao S, Wang G, Zhang Y, Wang T, Zou P, Wang J, Yao T, Chen M, Zhou C. Studies on novel diagnostic and predictive biomarkers of intrahepatic cholestasis of pregnancy through metabolomics and proteomics. Frontiers in Immunology. 2021 Oct 14;12:733225.