Evaluating the Utility of Liver Transaminases as Predictors of Feto-Maternal Outcome in Lieu of Serum Bile Acids in Intrahepatic Cholestasis of Pregnancy: A Prospective Observational Study

Devyani Misra; Neetu Singh; Mariyam Faruqi; Vandana Tiwari; Vandana Kumar; Farah Zafar

doi:10.1007/s13224-023-01881-6

Evaluating the Utility of Liver Transaminases as Predictors of Feto-Maternal Outcome in Lieu of Serum Bile Acids in Intrahepatic Cholestasis of Pregnancy: A Prospective Observational Study

J Obstet Gynaecol India. 2024 Apr;74(2):113-118. doi: 10.1007/s13224-023-01881-6. Epub 2023 Dec 30.

Authors

Devyani Misra¹, Neetu Singh², Mariyam Faruqi³, Vandana Tiwari⁴, Vandana Kumar⁵, Farah Zafar⁶

Affiliations

¹ AssiocProfessor Junior Grade, Department of Obstetrics & Gynaecology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh India.
² Professor Junior Grade, Department of Obstetrics & Gynaecology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh India.
³ Ex Senior Resident, Department of Obstetrics & Gynaecology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh India.
⁴ Professor Junior Grade, Department of Biochemistry, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh India.
⁵ Assistant Professor, Department of Obstetrics & Gynaecology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh India.
⁶ Ex Junior Resident, Department of Obstetrics & Gynaecology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh India.

PMID: 38707884
PMCID: PMC11065801 (available on 2025-04-01)
DOI: 10.1007/s13224-023-01881-6

Abstract

Introduction: Intrahepatic Cholestasis of Pregnancy (ICP) is a disorder of the second half of pregnancy causing pruritus and abnormal liver function tests (LFT). Incidence in India is 1.2-1.5%. ICP leads to adverse feto-maternal outcomes with early delivery indicated before serum bile acids (SBA) (gold standard) and hepatic transaminases are critically high. With paucity of evidence these levels are not well defined.

Objectives: To determine the association of liver transaminases with pregnancy outcomes in ICP and evaluate critical levels for prediction of adverse outcomes.

Material and methods: A prospective observational study was conducted comprising 88 pregnant women with pruritus not associated with rash. After history and examination, LFT and SBA levels were done, treatment given and followed till pregnancy termination to determine the feto-maternal outcome.

Results: The mean age of participants was 26.43 ± 3.35 years. The mean SBA, ALT and AST levels were 18.97 ± 10.320 μmol/L, 206.06 ± 45.71units/litre and 175.37 ± 101.088 units/litre respectively. 39.7% of participants were symptomatic for ICP while 38.6% responded to treatment. 34.1% underwent LSCS majorly (43.3%) formeconiumand 23.3% had foetal distress. 33% had preterm delivery. 5.68% of the neonates needed NICU admission and 6.8% had respiratory distress syndrome. The cut off for ALT on ROC curve analysis was 151.5 units/litre with AUC as 0.905, sensitivity and specificity of 89.7 and 70% respectively.

Conclusion: ICP leads to adverse pregnancy outcomes. ALT is a promising predictor of adverse outcome and termination of pregnancy can be planned accordingly.

Keywords: Intrahepatic cholestasis of pregnancy; Liver transaminases; Pruritus in pregnancy; Serum bile acids.

© Federation of Obstetric & Gynecological Societies of India 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.