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592: Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy
Poster Session IV
ajog.org RESULTS: 1) Newborns with EONS had higher cord blood hepcidin levels (p¼0.018) that correlated with IL-6 (r¼0.33, p¼0.001); 2) Maternal blood hepcidin levels did not differ between groups and did not correlate with cord blood hepcidin; 3) Hepcidin and ferroportin co-localized at the apical surface of syncytiotrophoblast and fetal vascular endothelium; 4) Placental ferroportin mRNA (but not hepcidin) was correlated with cord blood hepcidin (r¼0.46, p¼0.039) and severity of funisitis (r¼0.50, p¼0.018); 5) Newborns that expired in the setting of sepsis (n¼4) had higher hepcidin and lower ferroportin immunostaining in the liver (all, p<0.05) compared to those who died at a similar age of other causes (n¼4). CONCLUSION: Premature fetuses with EONS have elevated circulating hepcidin levels which likely relates to the altered expression of ferroportin in the liver and placenta. The fetal hepcidin-ferroportin interaction appears to play a role in the pathophysiology of EONS independently of the maternal response to an intrauterine inflammatory process.
Demographic data and pregnancy outcomes of patients with intrahepatic cholestasis of pregnancy by bile acid level
592 Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy
Tetsuya Kawakita1, Laura Parikh1, Uma Reddy1, Patrick Ramsey1, Angie Jelin1, Samuel Smith2, Sara Iqbal1 1 Medstar Washington Hospital Center, Obstetrics and Gynecology, Washington, DC, 2Medstar Franklin Square Medical Center, Obstetrics and Gynecology, Baltimore, MD
OBJECTIVE: To determine the predictors of adverse neonatal outcomes in patients with intrahepatic cholestasis of pregnancy (ICP). STUDY DESIGN: We conducted a multicenter retrospective cohort study of all women diagnosed with ICP across four hospital facilities from 2006 to 2013. ICP was diagnosed by maternal pruritis associated with total bile acid (TBA) levels > 10 mmol/L. We calculated the rate of severe neonatal morbidity (composite of neonatal intensive care unit admission, neonatal hyperbirilubinemia, hypoglycemia, respiratory distress syndrome, transient tachypnea of the newborn, mechanical ventilation use, need for neonatal oxygen with nasal cannula, pneumonia, and stillbirth) according to severity of bile acid elevation (mild ICP, TBA 10 to 39.9 mmol/L; moderate ICP, TBA 40 to 99.9 mmol/L; severe ICP, TBA >100 mmol/L). Mild ICP was used as a reference. Chi-Square and Fisher’s exact tests were used to compare outcomes. One-way analysis of variance (ANOVA), logistic regression, and receiver operating characteristic (ROC) curve were also used to predict neonatal complications. RESULTS: A total of 95 women with documented ICP were identified. There was no difference in maternal age, race, parity, or pre-pregnancy body mass index according to TBA level. There were 56 women with mild ICP, 25 with moderate ICP, and 14 with severe ICP. The rate of severe neonatal morbidity in mild, moderate and severe ICP was 22%, 48%, and 43% respectively (p¼0.04) (Table). Women with moderate or severe IPC were more likely to deliver preterm at less than 37 weeks gestation compared to women with mild ICP (p¼0.02). TBA above 39.8 mmol/L was associated with severe neonatal morbidity (p¼ 0.01, RR 2.12, 95%CI¼1.16-3.87, AUC 0.67). There were two stillbirths at 29 and 35 weeks of gestation, both observed in women with severe ICP. CONCLUSION: Moderate and severe ICP were associated with severe neonatal morbidity and preterm delivery. TBA level above 39.8 mmol/L was associated with severe neonatal morbidity. Stillbirth was associated with severe ICP.
a
Maternal BMI (body mass index) is categorized as underweight if BMI is <18.5 kg/m2, normal weight if BMI is 18.5 to 24.9 kg/m2, overweight if BMI is 25.0 to 29.9 kg/m2, obese if BMI is 30.0 to 34.9 kg/m2, and morbidly obese if BMI is >¼35.0 kg/m2 b Any diabetes includes preexisting diabetes and gestational diabetes c ICP (intrahepatic cholestasis of pregnancy) d NICU (Neonatal Intensive Care Unit) e Hypoglycemia that required intravenous infusion f Hyperbilirubinemia which required phototherapy g RDS (respiratory distress syndrome) or TTN (transient tachypnea of newborn) h Mechanical Ventilation: Intubation or Continuous positive airway pressure i Severe neonatal morbidity: composite of NICU admission, neonatal hyperbirilubinemia, hypoglycemia, RDS, TTN, mechanical ventilation use, need for neonatal oxygen with nasal cannula, pneumonia, and stillbirth
Supplement to JANUARY 2015 American Journal of Obstetrics & Gynecology
S295
ajog.org RESULTS: 1) Newborns with EONS had higher cord blood hepcidin levels (p¼0.018) that correlated with IL-6 (r¼0.33, p¼0.001); 2) Maternal blood hepcidin levels did not differ between groups and did not correlate with cord blood hepcidin; 3) Hepcidin and ferroportin co-localized at the apical surface of syncytiotrophoblast and fetal vascular endothelium; 4) Placental ferroportin mRNA (but not hepcidin) was correlated with cord blood hepcidin (r¼0.46, p¼0.039) and severity of funisitis (r¼0.50, p¼0.018); 5) Newborns that expired in the setting of sepsis (n¼4) had higher hepcidin and lower ferroportin immunostaining in the liver (all, p<0.05) compared to those who died at a similar age of other causes (n¼4). CONCLUSION: Premature fetuses with EONS have elevated circulating hepcidin levels which likely relates to the altered expression of ferroportin in the liver and placenta. The fetal hepcidin-ferroportin interaction appears to play a role in the pathophysiology of EONS independently of the maternal response to an intrauterine inflammatory process.
Demographic data and pregnancy outcomes of patients with intrahepatic cholestasis of pregnancy by bile acid level
592 Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy
Tetsuya Kawakita1, Laura Parikh1, Uma Reddy1, Patrick Ramsey1, Angie Jelin1, Samuel Smith2, Sara Iqbal1 1 Medstar Washington Hospital Center, Obstetrics and Gynecology, Washington, DC, 2Medstar Franklin Square Medical Center, Obstetrics and Gynecology, Baltimore, MD
OBJECTIVE: To determine the predictors of adverse neonatal outcomes in patients with intrahepatic cholestasis of pregnancy (ICP). STUDY DESIGN: We conducted a multicenter retrospective cohort study of all women diagnosed with ICP across four hospital facilities from 2006 to 2013. ICP was diagnosed by maternal pruritis associated with total bile acid (TBA) levels > 10 mmol/L. We calculated the rate of severe neonatal morbidity (composite of neonatal intensive care unit admission, neonatal hyperbirilubinemia, hypoglycemia, respiratory distress syndrome, transient tachypnea of the newborn, mechanical ventilation use, need for neonatal oxygen with nasal cannula, pneumonia, and stillbirth) according to severity of bile acid elevation (mild ICP, TBA 10 to 39.9 mmol/L; moderate ICP, TBA 40 to 99.9 mmol/L; severe ICP, TBA >100 mmol/L). Mild ICP was used as a reference. Chi-Square and Fisher’s exact tests were used to compare outcomes. One-way analysis of variance (ANOVA), logistic regression, and receiver operating characteristic (ROC) curve were also used to predict neonatal complications. RESULTS: A total of 95 women with documented ICP were identified. There was no difference in maternal age, race, parity, or pre-pregnancy body mass index according to TBA level. There were 56 women with mild ICP, 25 with moderate ICP, and 14 with severe ICP. The rate of severe neonatal morbidity in mild, moderate and severe ICP was 22%, 48%, and 43% respectively (p¼0.04) (Table). Women with moderate or severe IPC were more likely to deliver preterm at less than 37 weeks gestation compared to women with mild ICP (p¼0.02). TBA above 39.8 mmol/L was associated with severe neonatal morbidity (p¼ 0.01, RR 2.12, 95%CI¼1.16-3.87, AUC 0.67). There were two stillbirths at 29 and 35 weeks of gestation, both observed in women with severe ICP. CONCLUSION: Moderate and severe ICP were associated with severe neonatal morbidity and preterm delivery. TBA level above 39.8 mmol/L was associated with severe neonatal morbidity. Stillbirth was associated with severe ICP.
a
Maternal BMI (body mass index) is categorized as underweight if BMI is <18.5 kg/m2, normal weight if BMI is 18.5 to 24.9 kg/m2, overweight if BMI is 25.0 to 29.9 kg/m2, obese if BMI is 30.0 to 34.9 kg/m2, and morbidly obese if BMI is >¼35.0 kg/m2 b Any diabetes includes preexisting diabetes and gestational diabetes c ICP (intrahepatic cholestasis of pregnancy) d NICU (Neonatal Intensive Care Unit) e Hypoglycemia that required intravenous infusion f Hyperbilirubinemia which required phototherapy g RDS (respiratory distress syndrome) or TTN (transient tachypnea of newborn) h Mechanical Ventilation: Intubation or Continuous positive airway pressure i Severe neonatal morbidity: composite of NICU admission, neonatal hyperbirilubinemia, hypoglycemia, RDS, TTN, mechanical ventilation use, need for neonatal oxygen with nasal cannula, pneumonia, and stillbirth
Supplement to JANUARY 2015 American Journal of Obstetrics & Gynecology
S295