Can the Severity of Intrahepatic Cholestasis of Pregnancy be Predicted by Second Trimester Screening Test Parameters?
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ORIGINAL ARTICLE
Can the Severity of Intrahepatic Cholestasis of Pregnancy be Predicted by Second Trimester Screening Test Parameters? Samettin Celik1 • Banuhan Sahin2 • Canan Soyer-Calıskan1 • Handan Celik3 Safak Hatirnaz4
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Received: 19 January 2020 / Accepted: 17 July 2020 Ó Society of Fetal Medicine 2020
Abstract Objective The second trimester triple test although declared inadequate for the screening of aneuploidies by the International Society for Prenatal Diagnosis remains a widely employed test. We aim to investigate the associations between the biochemical parameters of the triple test and the severity of intrahepatic cholestasis of pregnancy (ICP). Material and Methods The triple test parameters of 102 healthy pregnant women and 100 pregnant women with ICP were evaluated retrospectively. Serum bile acid level of C 40 lmol/L was categorized as severe ICP. Serum afetoprotein (AFP), b-human chorionic gonadotropin (bhCG), and unconjugated estriol (uE3) multiple of the median (MoM) values and the perinatal outcomes were recorded. The Student’s t-test, Mann–Whitney U test, Kruskal–Wallis test, and receiver operating characteristic curve analysis were used to compare the data. Results The AFP, b-hCG, and uE3 MoM values were higher in the severe ICP group when compared to those with mild ICP and those without ICP (p \ 0.01). The sensitivity and specificity values for ICP were 80.95% and 73.42%, respectively, with AFP values C 1.26 MoM, & Handan Celik [email protected] 1
Maternity Hospital, A Branch of Training and Research Hospital, Samsun, Turkey
2
Department of Obstetrics and Gynecology, Amasya University, Amasya, Turkey
3
Department of Obstetrics and Gynecology, Ondokuzmayıs University, Samsun 55080, Turkey
4
Medicana International Hospital, IVF Center, Samsun, Turkey
76.19% and 88.61%, respectively, with b-hCG values C 1.78 MoM, and 61.90% and 94.94%, respectively, with uE3 values C 1.58 MoM [95% confidence interval; area under the curve (AUC) ± standard error (SE) = 0.810 ± 0.049, AUC ± SE: 0.790 ± 0.065, and AUC ± SE: 0.797 ± 0.065, respectively]. Conclusion An increase in the AFP, b-hCG, and uE3 MoM values in the triple test can predict the risk of developing severe ICP. Keywords Intrahepatic cholestasis of pregnancy Triple test Prediction
Introduction Intrahepatic cholestasis of pregnancy (ICP) is a pregnancyspecific liver disorder characterized by an increase in the serum bile acid level of C 10 lmol/L and itching, especially on the palms of the hands and the soles of the feet. It regresses spontaneously during the postnatal period, but it may recur in subsequent pregnancies [1]. The incidence of ICP has been reported to be between 0.3 and 5.6%, but it varies widely with ethnicity, geographical location, and seasonal changes [2]. Although genetic, endocrine, and environmental factors have been implicated in the etiology, the underlying pathophysiology has not yet been clarified [3]. ICP may result in maternal complications, such as preeclampsia, gestational diabetes mellitus (GDM
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