Perinatal outcome of newborns improve partially even after treatment of women with intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy has been consistently associated with a higher incidence of adverse pregnancy outcomes, including spontaneous and iatrogenic preterm delivery, non-reassuring fetal status, meconium staining of the amniotic fluid, and still birth. The risk of complications for the fetus is associated with the serum level of maternal serum bile acids, and women with more severe cholestasis are at greater risk.

Food allergy is a global public health problem, which affects around 8% of children in the world, is a potentially life-threatening condition that affects millions of children. Children living with FA often experience impaired health-related quality of life, have frequent school absences, and are at an increased risk of emergency department (ED) utilization and hospitalizations for care. Previous studies have shown that children's food allergy may be closely related to family genetic history and abnormal maternal metabolism during pregnancy. Increasingly intrahepatic cholestasis of pregnancy is recognized to be associated with an abnormal metabolic profile.

In the present study, L. Huang et al aimed to investigate the status of serum total bile acid in pregnant women in a longitudinal intrahepatic cholestasis of pregnancy study from Southwest China. Given the findings reported in study, authors also aimed to determine the impact of maternal serum total bile acid levels on maternal and neonatal outcomes as well as child growth and food allergy. The results of study showed that although the incidence of MSAF does vary significantly, there was no significant difference in the incidence of neonatal asphyxia among the mothers without intrahepatic cholestasis of pregnancy, with mild and severe intrahepatic cholestasis of pregnancy groups.

A retrospective longitudinal cohort investigation was carried out among 751 pregnant women with intrahepatic cholestasis of pregnancy at 30-32 weeks of gestation from the Longitudinal Intrahepatic Cholestasis of Pregnancy Study (LoICPS). Data on the characteristics of the mothers and neonates were collected. Infant growth data and food sensitivities were also collected.

In this cohort, the average maternal serum total bile acid level was 35.09±30.02 μmol/L, with 58.8% of mothers suffering from mild intrahepatic cholestasis of pregnancy and 29.2% suffering from severe intrahepatic cholestasis of pregnancy. Positive correlations were found between maternal serum total bile acid levels and twin pregnancy (P = 0.009) and meconium stained amniotic fluid (P < 0.001). In addition, the infants of mothers with severe intrahepatic cholestasis of pregnancy were more likely to be allergic to foods at 6 months.

The results of study showed that although the incidence of MSAF does vary significantly, there was no significant difference in the incidence of neonatal asphyxia among the mothers without intrahepatic cholestasis of pregnancy, with mild and severe intrahepatic cholestasis of pregnancy groups. This may be because the terminated gestation weeks of pregnancy were different among the three groups.

Authors found that maternal serum total bile acid levels worsened among twin pregnancies. Pregnant women with twin pregnancy have higher fasting serum total bile acid levels and are more likely to suffer from severe intrahepatic cholestasis of pregnancy. This can be attributed to women who are pregnant with twins undergo more complex physiological changes.

In study cohort, there was a significant positive correlation between itching symptom and serum total bile acid levels in pregnant women. This suggests that more attention should be paid to the serum total bile acid levels of pregnant women with twins and itching symptom in the third trimester. Comprehensive evaluation of serum total bile acid levels and risk factors of pregnant women, and selection of appropriate terminated time of pregnancy may be helpful to decrease the incidence of adverse perinatal outcomes.

Authors compared the status of infants allergic to foods by maternal serum total bile acid levels. A significant difference in the incidence of infantile food allergy were found among the mothers without intrahepatic cholestasis of pregnancy, with mild and severe intrahepatic cholestasis of pregnancy groups. The food allergy rates of fetuses were close between the mothers without intrahepatic cholestasis of pregnancy and with mild intrahepatic cholestasis of pregnancy groups, but the rate was significantly higher in severe intrahepatic cholestasis of pregnancy groups. Although no significant difference was found among the three groups in terms of the number of food allergic kinds, the number was highest in the mothers with severe intrahepatic cholestasis of pregnancy group. However, the terminated gestation weeks of pregnancy and drug use were different among the three groups, so it could not be simply concluded that maternal high serum total bile acid levels caused the infantile food allergy. It is worth exploring whether maternal serum total bile acid levels predominantly influences infant allergies to foods through further research.

"In summary, this study suggested that despite pregnant women with intrahepatic cholestasis of pregnancy taking ursodeoxycholic acid tablets and cesarean section before expected date of childbirth, the perinatal outcome of newborns partially improving, the incidence of infantile food allergy was still increased."

Source: L. Huang et al.; European Journal of Obstetrics & Gynecology and Reproductive Biology 272 (2022) 110–115

https://doi.org/10.1016/j.ejogrb.2022.03.026