To correlate maternal serum total bile acids and fetomaternal outcomes in obstetric cholestasis

• Author Details:   
• Sripriya Sridhar ^*
• Rita Tirkey
• Arunima Jyoti Sanga

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Background: Intrahepatic cholestasis of pregnancy (ICP) is a unique pregnancy dermatosis and cholestatic disorder characterized by pruritus in 2nd and 3rd trimesters of pregnancy. It can be diagnosed using increased level of serum bile acids and by excluding other liver and skin disorders. ICP causes significant risks to both maternal and fetal health. The main aim of this study is to analyse the differing levels of maternal serum TBA that correlate with both maternal and fetal outcomes in obstetric cholestasis.

Materials and Methods: A prospective observational and comparative study was carried out for over 12 months in the Department of Obstetrics & Gynaecology at Bokaro General Hospital, India. It involved 84 pregnant women with ICP. Participants were categorized into two groups based on serum TBA levels. Based on inclusion and exclusion criteria maternal and fetal outcomes were assessed through clinical history and examination, laboratory tests, and regular fetal monitoring using non-stress tests and obstetric ultrasound and Doppler studies. Statistical analysis was performed by SPSS version 24.

Results: 84 patients in this study were divided into two groups equally based on bile acid levels, group A (< 40 µmol/L) and group B (≥ 40 µmol/L). The mean bile acid levels in group A and group B were 16.40 ± 4.47 µmol/L and 43.86 ± 3.93 µmol/L respectively with p < 0.0001. Significant differences were observed in gestational age of 76.19% in group A delivered at 37 weeks, compared to only 9.52% in group B with p < 0.0001. 2.38% in group A and 64.29% in group B were observed in NICU admission due to respiratory distress. In group B 47.62% of babies weighed < 2.5 kg. In group B, 66.67% babies had MSAF vs 21.43% babies in group A. Other factors like APGAR score comparison also showed statistical significance.

Conclusion: TBA can be used as a predictive biomarker for adverse outcomes in ICP. This study states the need for early detection and intervention, especially in high-risk populations.