Determination And Significance Of Maternal-Fetal Lithocholic Acid And Umbilical Cord Blood Free Bilirubin Of Intrahepatic Cholestasis Of Pregnancy

Objective 1.To investigate the bile acids profile in serum of patients and fetals with intrahepatic cholestasis of pregnancy (ICP), and the relationship among the concentrations of lithocholic acid (LCA), the severity and adverse pregnancy outcomes of ICP.2. To investigate the relationship among the concentrations of umbilical cord blood free bilirubin, the severity and adverse pregnancy outcomes of ICP.Methods 1.A control group, a mild ICP group and a severe ICP group was selected, each group size was of 20 patients. Detect bile acids profile in serum of these patients and fetals by high performance liquid chromatography tandem mass spectrometry, including 7 kinds of bile acids: lithocholic acid (LCA), glycocholic acid (GCA), taurocholic acid (TCA), cholic acid (CA), chenodeoxycholic acid (CDCA), ursodeoxycholic acid (UDCA), taurolithocholic acid (TLCA). Analysisthe characteristic of the bile acid profile in serum of patients and fetals with ICP, the correlation between the concentration of maternal serum LCA and maternal liver function of ICP and the relationship between the concentration of maternal-fetal serum LCA and pregnancy outcomes of ICP.2.A control group and a ICP group were selected, the first group size was of 22 patients and the second was of 31. Detect umbilical cord blood free bilirubin of the two groups and fetals by high performance liquid chromatography. Analysis the correlation between the concentration of umbilical cord blood free bilirubin andmaternal liver function of ICP and the relationship between it and pregnancy outcomes of ICP.Results 1.①Characteristics of maternal serum bile acid profile: TCA, GCA in mild ICP group is higher than in control group, LCA, TCA, GCA, TLCA in severe ICP group is higher than in control group, UDCA in severe ICP group is lower than in control group, LCA, TCA, GCA, TLCA in severe ICP group is higher than in mild ICP group, there were statistically significant differences of all.(P<0.05).②Characteristics of umbilical cord blood serum bile acid profile: TCA, GCA in mild ICP group is higher than in control group, LCA, TCA, GCA, CA, TLCA in severe ICP group is higher than in control group, UDCA in severe ICP group is lower than in control group, TCA, GCA, CA in severe ICP group is higher than in mild ICP group, UDCA in severe ICP group is lower than in mild ICP group, there were statistically significant differences of all (P <0.05).③Compared bile acid profile with maternal serum and umbilical cord blood serum: there were no statistically significant differences of LCA, TCA, GCA, CDCA, CA, UDCA, TLCA in maternal and umbilical cord blood serum of control group and mild ICP group (P>0.05), LCA, TCA, GCA, UDCA, TLCA in maternal serum of severe ICP group is higher than in umbilical cord blood serum, there were statistically significant differences(P<0.05).④The correlation between maternal serum LCA and liver function of ICP: In mild ICP group, there is a positive correlation between maternal serum LCA and ALT, AST, TBIL, DBIL (r= 0.302-0.413, P<0.05). In severe ICP group, there is a positive correlation between maternal serum LCA and ALT, AST, TBIL, DBIL (r= 0.403-0.502, P<0.05).⑤Compared with pregnancy outcomes and LCA of ICP:In mild and severe ICP group, the concentration of maternal serum LCA in meconium-stained amniotic fluid group, premature group and meconium-stained amniotic fluid plus premature group is higher than in normal pregnancy outcome group respectively, and the same in the umbilical cord blood serum LCA, there were statistically significant differences(P<0.05). 2.①The concentration of umbilical cord blood free bilirubin in ICP group is higher than in control group, there were statistically significant differences(P<0.05).②In ICP group, there is a positive correlation between umbilical cord blood free bilirubin and ALT, AST , TBIL, DBIL (r=0.356-0.487, P<0.05).③In ICP group, the concentration of umbilical cord blood free bilirubin in meconium-stained amniotic fluid group, premature group and meconium-stained amniotic fluid plus premature group is higher than in normal pregnancy outcome group respectively, there were statistically significant differences (P<0.05). Conclusion 1.There were statistically significant differences in maternal-fetal serum bile acids profile between patients with ICP andnormal pregnant women. Lithocholic acid which is the most toxic bile acid, is correlated with different severities and adverse pregnancy outcomes of ICP. 2.The concentration of umbilical cord blood free bilirubin is higher in ICP group than in control group, which is one of the causes of abnormal liver function and poor foetal outcome in an ICP patient.