Predictors of Adverse Neonatal Outcomes in Intrahepatic Cholestasis of Pregnancy

Overview

Many studies have attempted to find the predictors of adverse neonatal outcome in women with Intrahepatic Cholestasis of Pregnancy(ICP).Serum total bile acid level exceeding 40 µmol/L has been associated with increased risk of meconium staining, low Apgar scores, preterm delivery, and stillbirth.Other predictors such as level of transaminases, history of cholelithiasis, and hepatitis virus infection have been studied but the results are inconclusive.A more comprehensive investigation involving multiple neonatal outcomes and a wide variety of outcome predictors is needed in order to establish guidelines for optimal timing of delivery in pregnancies complicated by ICP. The aim of our study was to evaluate wide variety of predictors of adverse neonatal outcomes in a large cohort of women with ICP .

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Retrospective
  • Study Primary Completion Date: December 31, 2020

Detailed Description

We performed a retrospective cohort study of all women diagnosed with ICP. Pregnancy outcomes including delivery gestational age, spontaneous preterm delivery, iatrogenic preterm delivery, birth weight, mode of delivery, oligohydramnios, intrauterine growth restriction (IUGR), placental abruption, preterm premature rupture of membrane (PPROM), concerning fetal heart tracing, chorioamnionitis, endometritis, postpartum hemorrhage, transfusion, stillbirth, neonatal intensive care unit (NICU) admission, hyperbilirubinemia, meconium stained amniotic fluid, respiratory distress syndrome(RDS) or transient tachypnea of newborn(TTN) (transient tachypnea of the newborn), and composite neonatal outcome were ascertained. A composite adverse neonatal outcome was created and defined as any of the following: NICU admission, hypoglycemia, hyperbilirubinemia, RDS, TTN, mechanical ventilation use, oxygen by nasal cannula, pneumonia, and stillbirth. PPROM was defined by rupture of membrane before 37 weeks gestation. Concerning fetal heart tracing was defined as recurrent variable or late decelerations with moderate variability, prolonged decelerations, or category 3 tracing. Providers who were caring for the women reviewed and independently characterized fetal heart tracings. Since fetal heart tracings were not accessible to authors, authors accepted the providers' interpretation. For analysis of concerning fetal heart tracing, women with non-labor cesarean section were excluded. Hyperbilirubinemia was defined by neonatal hyperbilirubinemia that required phototherapy. Hypoglycemia was defined by neonatal hypoglycemia that required intravenous infusion. Diagnosis of RDS and TTN were made by the managing neonatologist and based on standard clinical guidelines.

Arms, Groups and Cohorts

  • Hospitalization group
    • Newborns of ICP mothers require hospitalization after birth
  • without Hospitalization group
    • Newborns of ICP mothers don’t require hospitalization after birth

Clinical Trial Outcome Measures

Primary Measures

  • Hypoglycemia
    • Time Frame: up to 28 days
    • Hypoglycemia was defined by neonatal hypoglycemia that required intravenous infusion
  • Hyperbilirubinemia
    • Time Frame: up to 28 days
    • Hyperbilirubinemia was defined by neonatal hyperbilirubinemia that required phototherapy
  • NICU admission
    • Time Frame: up to 28 days
    • Newborns required hospitalization in the NICU after birth
  • RDS
    • Time Frame: up to 28 days
    • Newborns were diagnosed with respiratory distress syndrome
  • TTN
    • Time Frame: up to 28 days
    • Newborns were diagnosed with transient tachypnea of the newborn
  • mechanical ventilation use
    • Time Frame: up to 28 days
    • Newborns required mechanical ventilation
  • oxygen by nasal cannula
    • Time Frame: up to 28 days
    • Newborns required oxygen by nasal cannula
  • pneumonia
    • Time Frame: up to 28 days
    • Newborns were diagnosed with pneumonia
  • stillbirth
    • Time Frame: up to 1 day
    • newborns died after birth

Participating in This Clinical Trial

Inclusion Criteria

  • Newborns were born in maternal and child health hospital of Yong Chuan District from January 2012 to December 2020;②all Newborns' mothers diagnosed intrahepatic cholestasis of pregnancy. Exclusion Criteria:

The newborns were born with severe congenital heart disease and deformities

Gender Eligibility: All

Minimum Age: N/A

Maximum Age: 28 Days

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Daping Hospital and the Research Institute of Surgery of the Third Military Medical University
  • Collaborator
    • maternal and child health hospital of Yong Chuan District
  • Provider of Information About this Clinical Study
    • Principal Investigator: Chen Long,MD, Daping Hospital and the Research Institute of Surgery of the Third Military Medical University – Daping Hospital and the Research Institute of Surgery of the Third Military Medical University

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