Evaluation of Maternal and Fetal Outcomes and Biochemical Indices in Intrahepatic Cholestasis of Pregnancy

Abstract

Background: Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder associated with an increased risk of adverse perinatal outcomes. The aim of this study is to investigate biochemical indices as potential predictors of ICP and adverse outcomes.

Materials and Methods: This retrospective case-control study was conducted at a tertiary care center.A total of 134 pregnant women who delivered between June 2022 and December 2024 were included. Of these, 58 were diagnosed with ICP (study, Group 1) and 76 had no diagnosis of cholestasis (control, Group 2). Clinical and laboratory findings, as well as biochemical indices, were compared between the groups.

Results: In the study group, significant differences were observed in first-trimester albumin (p<0.001), alanine aminotransferase (ALT) (p=0.018), aspartate aminotransferase (AST) (p=0.007), third-trimester ALT and AST (p<0.001), first-trimester Albumin/Creatinine ratio (ALCIR), AST/Creatinine ratio (ACRI) (p<0.05), and AST/ALT ratio (De Ritis) (p<0.001), as well as third- trimester De Ritis and ACRI (p<0.001) and ALCIR (p=0.013). Receiver operating characteristic(ROC) analysis performed for the prediction of cholestasis in all patients demonstrated that first and third- trimester ACRI, De Ritis, and ALCIR were statistically significant (p<0.05). In the study group, ROC analysis for predicting composite adverse perinatal outcomes (CAPO) and neonatal intensive care ünit (NICU) revealed that third- trimester ACRI and De Ritis were significant predictors (p<0.05). Conclusions: In this study for all patients first and third-trimester ACRI, De Ritis, and ALCIR were significant predictors of cholestasis, while third-trimester ACRI and De Ritis predicted NICU and CAPO in the study group. Due to their low cost and clinical applicability, these indices may provide valuable contributions to the literature.

Keywords

• Intrahepatic cholestasis of pregnancy
• Aspartate aminotranferase
• Albumin
• Creatinine
• Neonatal intensive care units

Gebeliğin İntrahepatik Kolestazının Maternal ve Fetal Sonuçları ile Biyomkimyasal İndekslerinin İncelenmesi

Abstract

Amaç: Gebeliğin intrahepatik kolestazı (GİK), olumsuz perinatal sonuç riskinin arttığı gebeliğe özgü bir karaciğer hastalığıdır. Bu çalışmanın amacı biyokimyasal indekslerin, GİK ve olumsuz sonuçların öngörüsünde potansiyel belirteçler olarak araştırmaktır.

Materyal ve metod: Bu retrospektif vaka-kontrol çalışması, tersiyer basamak bir merkezde gerçekleştirildi. Çalışmaya haziran 2022, aralık 2024 tarihleri arasında kolestaz tanılı olan 58 ve kolestaz tanılı olmayan 76 gebe hasta dahil edildi. Hastalar çalışma (grup 1) ve kontrol (grup 2) şeklinde 2 gruba ayrıldı. Çalışma ve kontrol gruplarının sonuçları karşılaştırıldı.

Bulgular: Çalışma grubunda 1. trimester albümin (p<0,001), alanin aminotransferaz (ALT) (p=0,018), aspartat aminotransferaz (AST) (p=0,007), 3. trimester ALT, AST (p<0,001) 1. trimester Albumin/Kreatinin oranı (ALCIR), AST/Kreatinin oranı (ACRİ) (p<0,05), AST/ALT oranı (De Ritis) (p<0,001) ve 3. trimester De Ritis, ACRİ (p<0,001) ve ALCIR (p=0,013) açısından anlamlı farklılıklar izlendi. Tüm hastalarda kolestaz tahmini için yapılan alıcı işletim karakteristiği (ROC) analizinde 1. trimester ve 3. trimester ACRİ, DeRitis, ALCIR (p<0,05) anlamlı olarak görülmüştür.  Çalışma grubunda birleşik olumsuz gebelik sonuçları (CAPO) ve yeni doğan yoğunbakım ünitesine (NICU) yatış öngörüsü için yapılan ROC analizinde 3. trimester ACRİ ve De Ritis (p<0,05) anlamlı olarak izlenmiştir.

Sonuç: Bu çalışmada tüm hastalar değerlendirildiğinde 1. ve 3. trimester ACRİ, De Ritis ve ALCIR kolestaz öngörüsünde, çalışma grubu değerlendirildiğinde ise 3. trimester ACRİ ve De Ritis NICU ve CAPO öngörüsünde anlamlı olarak izlendi. Bu indekslerin kullanımı kolay ucuz ve klinik pratikte uygulanabilir olması sebebiyle kullanılabileceğini ve bu sebeple çalışmanın literatüre katkı sunacağını düşünmekteyiz.

Keywords

• Gebeliğin intrahepatik kolestazı
• Aspartataminotransferaz
• Albümin
• Kreatinin
• Yeni doğan yoğun bakım

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