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The value of prenatal indicators in predicting adverse fetal outcomes in patients with ICP
Jiahong Jiang1, Jun Zhou1, Litao Zhang1
1Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Insights
Cholestasis of pregnancy (ICP) patients with higher cholyglycine (CG) and lower fibrinogen (FIB) levels face increased risks of adverse fetal outcomes. These key laboratory markers can predict pregnancy complications in ICP.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Clinical Chemistry
Background:
- Intrahepatic cholestasis of pregnancy (ICP) is a serious condition affecting fetal well-being.
- Identifying reliable predictors of adverse fetal outcomes in ICP is crucial for timely intervention.
Purpose of the Study:
- To investigate specific laboratory markers in maternal blood that can predict adverse fetal pregnancy outcomes in patients diagnosed with ICP.
- To evaluate the association between prenatal laboratory indicators and adverse neonatal outcomes in ICP.
Main Methods:
- An observational case-control study involving 117 ICP patients and 100 controls.
- Collected and analyzed maternal antenatal laboratory markers, including liver enzymes, bilirubin, bile acids, and coagulation parameters.
- Utilized descriptive statistics and multivariate logistic regression to identify significant predictors of adverse fetal outcomes.
Main Results:
- Several laboratory markers, including alanine aminotransferase (ALT), total bile acids (TBA), cholyglycine (CG), prothrombin time (PT), and activated partial thromboplastin time (APTT), differed significantly between ICP patients and controls.
- In ICP patients, elevated TBA, CG, and direct bilirubin (DB), along with lower fibrinogen (FIB) levels, were associated with adverse fetal outcomes.
- Multivariate logistic regression identified CG (OR=1.06) and FIB (OR=0.54) as independent predictors of adverse fetal outcomes in ICP.
Conclusions:
- Prenatal cholyglycine (CG) and fibrinogen (FIB) levels are independently associated with adverse fetal outcomes in patients with intrahepatic cholestasis of pregnancy (ICP).
- These markers may serve as valuable tools for risk stratification and management of ICP pregnancies.
Abstract:
Search for laboratory markers that can predict adverse fetal pregnancy outcomes in patients with cholestasis of pregnancy.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.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.Prenatal CG and FIB levels were independently associated with adverse fetal outcomes in patients with ICP.
