Liver Transaminases as Predictors of Feto-Maternal Outcome in Intrahepatic Cholestasis of Pregnancy

Intrahepatic Cholestasis of Pregnancy (ICP) – a condition that occurs in the latter half of pregnancy, is characterized by pruritus and abnormal liver function tests (LFT). Its incidence in India ranges from 1.2-1.5%. ICP is associated with adverse outcomes for both the mother and fetus––necessitating early delivery before serum bile acids (SBA)––considered the gold standard. Here, hepatic transaminases reach critically high levels, yet specific threshold levels for these markers remain undefined due to a lack of conclusive evidence.

The objectives of this study were to establish the correlation between liver transaminases and pregnancy outcomes in ICP and to identify critical levels for predicting adverse outcomes.

This was a prospective observational study that enrolled 88 pregnant women experiencing pruritus without a rash. Following a comprehensive history and examination, LFT and SBA levels were assessed, and participants were monitored until the end of pregnancy – to evaluate feto-maternal outcomes.

The mean age of participants was 26.43 ± 3.35 years. The mean levels of SBA, ALT, and AST were 18.97 ± 10.320 μmol/L, 206.06 ± 45.71 units/liter, and 175.37 ± 101.088 units/liter, respectively. Approximately 39.7% of participants exhibited ICP symptoms, and 38.6% responded positively to treatment. Notably, 34.1% underwent a cesarean section, primarily due to meconium (43.3%), and 23.3% experienced fetal distress. Preterm delivery occurred in 33% of cases, with 5.68% of neonates requiring NICU admission and 6.8% exhibiting respiratory distress syndrome. The determined cut-off for ALT, as per ROC curve analysis, was 151.5 units/liter, with an AUC of 0.905, a sensitivity of 89.7%, and a specificity of 70%.

The results suggested that ICP is associated with unfavorable pregnancy outcomes, and ALT levels serve as a promising predictor for adverse outcomes, aiding in the planning of pregnancy termination.

Source: Misra D, Singh N, Faruqi M. et al. J Obstet Gynecol India. 2023.