Systematic Review: Correlation Between Fetal Death And Serum Bile Acids Level In Intrahepatic Cholestasis Of Pregnancy Patient

Objective: We explored the correlation of serum total bile acidsconcentration on intrahapatic cholestasis of pregnancy associates fetaldeath via a systematic review.Methods: Studies on relationship between fetal death and intrahapaticcholestasis of pregnancy or bile acids level were searched and analyzed inthe systematic review. Solfwere Revman5.2was adopted to analyzed thedata. Meta-analysis was conducted for the combinable case-control study,and descriptive system evaluation for the unspooled case-control study, casereport and case series.Results: Eighteen studies were included in this systematic review.According to the result of meta-analysis, the rate of ICP pregnant with fetaldeath was1.91%. Compared to normal pregnancy, the incidence of fetaldeath in ICP woman have statistically significant difference (p<0.00001).There was also a significant difference between cases with TBA≥40μmol/Land TBA<40μmol/L(p=0.0001) on fetal death complicating with ICP. Nine studies of case report and case series were included, in which26cases offetal death from6studies gave a description of bile acids concentration. Theserum total bile acid level was significantly elevated and most of them wereabove40umol/L, indicating that increasing risk of fetal death in the caseswith elevated bile acids. One case-control study was compared thedifference of bile acids level between581fetal deaths and1546live births.However, the mean value of bile acids concentration has no significantdifference.Conclusions: Our Systematic evaluation literature suggests that serumlevel of total bile acid above40μmol/L in ICP pregnant associatesincreased risk of fetal death. We also evaluated the serum level of bile acidbelow40μmol/L diagnosed with ICP also requires high alert to thepossibility of fetal deaths.