Re‐evaluating diagnostic thresholds for intrahepatic cholestasis of pregnancy: case–control and cohort study
Objective To determine the optimal total serum bile acid (TSBA) threshold and sampling time for accurate intrahepatic cholestasis of pregnancy (ICP) diagnosis. Design Case–control, retrospective cohort studies. Setting Antenatal clinics, clinical research facilities. Population Women with ICP or unc...
Gespeichert in:
| Veröffentlicht in: | BJOG : an international journal of obstetrics and gynaecology 2021-09, Vol.128 (10), p.1635-1644 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 1644 |
|---|---|
| container_issue | 10 |
| container_start_page | 1635 |
| container_title | BJOG : an international journal of obstetrics and gynaecology |
| container_volume | 128 |
| creator | Mitchell, AL Ovadia, C Syngelaki, A Souretis, K Martineau, M Girling, J Vasavan, T Fan, HM Seed, PT Chambers, J Walters, JRF Nicolaides, K Williamson, C |
| description | Objective
To determine the optimal total serum bile acid (TSBA) threshold and sampling time for accurate intrahepatic cholestasis of pregnancy (ICP) diagnosis.
Design
Case–control, retrospective cohort studies.
Setting
Antenatal clinics, clinical research facilities.
Population
Women with ICP or uncomplicated pregnancies.
Methods
Serial TSBA measurements were performed pre‐/postprandially in 42 women with ICP or uncomplicated pregnancy. Third‐trimester non‐fasting TSBA reference ranges were calculated from 561 women of black, south Asian and white ethnicity. Rates of adverse perinatal outcomes for women with ICP but peak non‐fasting TSBA below the upper reference range limit were compared with those in healthy populations.
Main outcome measures
Sensitivity and specificity of common TSBA thresholds for ICP diagnosis, using fasting and postprandial TSBA. Calculation of normal reference ranges of non‐fasting TSBA.
Results
Concentrations of TSBA increased markedly postprandially in all groups, with overlap between healthy pregnancy and mild ICP (TSBA |
| doi_str_mv | 10.1111/1471-0528.16669 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2489601748</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2489601748</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4129-94c8bfe675850585fea46429d903beece7982cda0a82036bbbee4f11fa0fd1243</originalsourceid><addsrcrecordid>eNqFkc1KxDAUhYMojn9rdxJw46ZjkqaZ1J0O_iIIouuQpjczlU5Tk1aZnY8g-IY-iRlHZ-HGQEg4-e7h5lyE9ikZ0riOKR_RhGRMDqkQIl9DWytl_ftOEpIyOUDbITwRQgUj6SYapGkmRcr4Fmrv4fPtHV503euuaia4rPSkcaGrDO6mHsLU1WXA1nlcNZ3XU2j14s1EHUKnQxWws7j1MGl0Y-Yn2OgQLT-Mi7irsW5KbNzU-Q6Hri_nu2jD6jrA3s-5gx4vzh_GV8nt3eX1-PQ2MZyyPMm5kYUFMcpkRuK2oLngLC9zkhYABka5ZKbURMv4JVEUUeSWUquJLSnj6Q46Wvq23j33sVU1q4KButYNuD4oxmUuCB1xGdHDP-iT630Tu1MsE5STLKcsUsdLyngXggerWl_NtJ8rStRiGGoRvVpEr76HESsOfnz7Ygbliv9NPwLZEnitapj_56fObu6Wxl_6QZdS</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2561405912</pqid></control><display><type>article</type><title>Re‐evaluating diagnostic thresholds for intrahepatic cholestasis of pregnancy: case–control and cohort study</title><source>Wiley Online Library Journals Frontfile Complete</source><creator>Mitchell, AL ; Ovadia, C ; Syngelaki, A ; Souretis, K ; Martineau, M ; Girling, J ; Vasavan, T ; Fan, HM ; Seed, PT ; Chambers, J ; Walters, JRF ; Nicolaides, K ; Williamson, C</creator><creatorcontrib>Mitchell, AL ; Ovadia, C ; Syngelaki, A ; Souretis, K ; Martineau, M ; Girling, J ; Vasavan, T ; Fan, HM ; Seed, PT ; Chambers, J ; Walters, JRF ; Nicolaides, K ; Williamson, C</creatorcontrib><description>Objective
To determine the optimal total serum bile acid (TSBA) threshold and sampling time for accurate intrahepatic cholestasis of pregnancy (ICP) diagnosis.
Design
Case–control, retrospective cohort studies.
Setting
Antenatal clinics, clinical research facilities.
Population
Women with ICP or uncomplicated pregnancies.
Methods
Serial TSBA measurements were performed pre‐/postprandially in 42 women with ICP or uncomplicated pregnancy. Third‐trimester non‐fasting TSBA reference ranges were calculated from 561 women of black, south Asian and white ethnicity. Rates of adverse perinatal outcomes for women with ICP but peak non‐fasting TSBA below the upper reference range limit were compared with those in healthy populations.
Main outcome measures
Sensitivity and specificity of common TSBA thresholds for ICP diagnosis, using fasting and postprandial TSBA. Calculation of normal reference ranges of non‐fasting TSBA.
Results
Concentrations of TSBA increased markedly postprandially in all groups, with overlap between healthy pregnancy and mild ICP (TSBA <40 μmol/l). The specificity of ICP diagnosis was higher when fasting, but corresponded to <30% sensitivity for diagnosis of mild disease. Using TSBA ≥40 μmol/l to define severe ICP, fasting measurements identified 9% (1/11), whereas non‐fasting measurements detected over 91% with severe ICP. The highest upper limit of the non‐fasting TSBA reference range was 18.3 µmol/l (95% confidence interval: 15.0–35.6 μmol/l). A re‐evaluation of published ICP meta‐analysis data demonstrated no increase in spontaneous preterm birth or stillbirth in women with TSBA <19 µmol/l.
Conclusions
Postprandial TSBA levels are required to identify high‐risk ICP pregnancies (TSBA ≥40 μmol/l). The postprandial rise in TSBA in normal pregnancy indicates that a non‐fasting threshold of ≥19 µmol/l would improve diagnostic accuracy.
Tweetable
Non‐fasting bile acids improve the diagnostic accuracy of intrahepatic cholestasis of pregnancy diagnosis.
Tweetable
Non‐fasting bile acids improve the diagnostic accuracy of intrahepatic cholestasis of pregnancy diagnosis.
This article includes Author Insights, a video available at https://vimeo.com/bjog/authorinsights16669</description><identifier>ISSN: 1470-0328</identifier><identifier>EISSN: 1471-0528</identifier><identifier>DOI: 10.1111/1471-0528.16669</identifier><identifier>PMID: 33586324</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Bile acids ; Cholestasis ; Clinical decision making ; Cohort analysis ; Diagnosis ; Fasting ; Gallbladder diseases ; Liver diseases ; liver diseases in pregnancy ; Medical diagnosis ; Pregnancy ; Premature birth</subject><ispartof>BJOG : an international journal of obstetrics and gynaecology, 2021-09, Vol.128 (10), p.1635-1644</ispartof><rights>2021 The Authors. : An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.</rights><rights>2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.</rights><rights>2021. This article is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4129-94c8bfe675850585fea46429d903beece7982cda0a82036bbbee4f11fa0fd1243</citedby><cites>FETCH-LOGICAL-c4129-94c8bfe675850585fea46429d903beece7982cda0a82036bbbee4f11fa0fd1243</cites><orcidid>0000-0001-7904-7933 ; 0000-0002-6861-5779</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2F1471-0528.16669$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2F1471-0528.16669$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33586324$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mitchell, AL</creatorcontrib><creatorcontrib>Ovadia, C</creatorcontrib><creatorcontrib>Syngelaki, A</creatorcontrib><creatorcontrib>Souretis, K</creatorcontrib><creatorcontrib>Martineau, M</creatorcontrib><creatorcontrib>Girling, J</creatorcontrib><creatorcontrib>Vasavan, T</creatorcontrib><creatorcontrib>Fan, HM</creatorcontrib><creatorcontrib>Seed, PT</creatorcontrib><creatorcontrib>Chambers, J</creatorcontrib><creatorcontrib>Walters, JRF</creatorcontrib><creatorcontrib>Nicolaides, K</creatorcontrib><creatorcontrib>Williamson, C</creatorcontrib><title>Re‐evaluating diagnostic thresholds for intrahepatic cholestasis of pregnancy: case–control and cohort study</title><title>BJOG : an international journal of obstetrics and gynaecology</title><addtitle>BJOG</addtitle><description>Objective
To determine the optimal total serum bile acid (TSBA) threshold and sampling time for accurate intrahepatic cholestasis of pregnancy (ICP) diagnosis.
Design
Case–control, retrospective cohort studies.
Setting
Antenatal clinics, clinical research facilities.
Population
Women with ICP or uncomplicated pregnancies.
Methods
Serial TSBA measurements were performed pre‐/postprandially in 42 women with ICP or uncomplicated pregnancy. Third‐trimester non‐fasting TSBA reference ranges were calculated from 561 women of black, south Asian and white ethnicity. Rates of adverse perinatal outcomes for women with ICP but peak non‐fasting TSBA below the upper reference range limit were compared with those in healthy populations.
Main outcome measures
Sensitivity and specificity of common TSBA thresholds for ICP diagnosis, using fasting and postprandial TSBA. Calculation of normal reference ranges of non‐fasting TSBA.
Results
Concentrations of TSBA increased markedly postprandially in all groups, with overlap between healthy pregnancy and mild ICP (TSBA <40 μmol/l). The specificity of ICP diagnosis was higher when fasting, but corresponded to <30% sensitivity for diagnosis of mild disease. Using TSBA ≥40 μmol/l to define severe ICP, fasting measurements identified 9% (1/11), whereas non‐fasting measurements detected over 91% with severe ICP. The highest upper limit of the non‐fasting TSBA reference range was 18.3 µmol/l (95% confidence interval: 15.0–35.6 μmol/l). A re‐evaluation of published ICP meta‐analysis data demonstrated no increase in spontaneous preterm birth or stillbirth in women with TSBA <19 µmol/l.
Conclusions
Postprandial TSBA levels are required to identify high‐risk ICP pregnancies (TSBA ≥40 μmol/l). The postprandial rise in TSBA in normal pregnancy indicates that a non‐fasting threshold of ≥19 µmol/l would improve diagnostic accuracy.
Tweetable
Non‐fasting bile acids improve the diagnostic accuracy of intrahepatic cholestasis of pregnancy diagnosis.
Tweetable
Non‐fasting bile acids improve the diagnostic accuracy of intrahepatic cholestasis of pregnancy diagnosis.
This article includes Author Insights, a video available at https://vimeo.com/bjog/authorinsights16669</description><subject>Bile acids</subject><subject>Cholestasis</subject><subject>Clinical decision making</subject><subject>Cohort analysis</subject><subject>Diagnosis</subject><subject>Fasting</subject><subject>Gallbladder diseases</subject><subject>Liver diseases</subject><subject>liver diseases in pregnancy</subject><subject>Medical diagnosis</subject><subject>Pregnancy</subject><subject>Premature birth</subject><issn>1470-0328</issn><issn>1471-0528</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><recordid>eNqFkc1KxDAUhYMojn9rdxJw46ZjkqaZ1J0O_iIIouuQpjczlU5Tk1aZnY8g-IY-iRlHZ-HGQEg4-e7h5lyE9ikZ0riOKR_RhGRMDqkQIl9DWytl_ftOEpIyOUDbITwRQgUj6SYapGkmRcr4Fmrv4fPtHV503euuaia4rPSkcaGrDO6mHsLU1WXA1nlcNZ3XU2j14s1EHUKnQxWws7j1MGl0Y-Yn2OgQLT-Mi7irsW5KbNzU-Q6Hri_nu2jD6jrA3s-5gx4vzh_GV8nt3eX1-PQ2MZyyPMm5kYUFMcpkRuK2oLngLC9zkhYABka5ZKbURMv4JVEUUeSWUquJLSnj6Q46Wvq23j33sVU1q4KButYNuD4oxmUuCB1xGdHDP-iT630Tu1MsE5STLKcsUsdLyngXggerWl_NtJ8rStRiGGoRvVpEr76HESsOfnz7Ygbliv9NPwLZEnitapj_56fObu6Wxl_6QZdS</recordid><startdate>202109</startdate><enddate>202109</enddate><creator>Mitchell, AL</creator><creator>Ovadia, C</creator><creator>Syngelaki, A</creator><creator>Souretis, K</creator><creator>Martineau, M</creator><creator>Girling, J</creator><creator>Vasavan, T</creator><creator>Fan, HM</creator><creator>Seed, PT</creator><creator>Chambers, J</creator><creator>Walters, JRF</creator><creator>Nicolaides, K</creator><creator>Williamson, C</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7904-7933</orcidid><orcidid>https://orcid.org/0000-0002-6861-5779</orcidid></search><sort><creationdate>202109</creationdate><title>Re‐evaluating diagnostic thresholds for intrahepatic cholestasis of pregnancy: case–control and cohort study</title><author>Mitchell, AL ; Ovadia, C ; Syngelaki, A ; Souretis, K ; Martineau, M ; Girling, J ; Vasavan, T ; Fan, HM ; Seed, PT ; Chambers, J ; Walters, JRF ; Nicolaides, K ; Williamson, C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4129-94c8bfe675850585fea46429d903beece7982cda0a82036bbbee4f11fa0fd1243</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Bile acids</topic><topic>Cholestasis</topic><topic>Clinical decision making</topic><topic>Cohort analysis</topic><topic>Diagnosis</topic><topic>Fasting</topic><topic>Gallbladder diseases</topic><topic>Liver diseases</topic><topic>liver diseases in pregnancy</topic><topic>Medical diagnosis</topic><topic>Pregnancy</topic><topic>Premature birth</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mitchell, AL</creatorcontrib><creatorcontrib>Ovadia, C</creatorcontrib><creatorcontrib>Syngelaki, A</creatorcontrib><creatorcontrib>Souretis, K</creatorcontrib><creatorcontrib>Martineau, M</creatorcontrib><creatorcontrib>Girling, J</creatorcontrib><creatorcontrib>Vasavan, T</creatorcontrib><creatorcontrib>Fan, HM</creatorcontrib><creatorcontrib>Seed, PT</creatorcontrib><creatorcontrib>Chambers, J</creatorcontrib><creatorcontrib>Walters, JRF</creatorcontrib><creatorcontrib>Nicolaides, K</creatorcontrib><creatorcontrib>Williamson, C</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>BJOG : an international journal of obstetrics and gynaecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mitchell, AL</au><au>Ovadia, C</au><au>Syngelaki, A</au><au>Souretis, K</au><au>Martineau, M</au><au>Girling, J</au><au>Vasavan, T</au><au>Fan, HM</au><au>Seed, PT</au><au>Chambers, J</au><au>Walters, JRF</au><au>Nicolaides, K</au><au>Williamson, C</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Re‐evaluating diagnostic thresholds for intrahepatic cholestasis of pregnancy: case–control and cohort study</atitle><jtitle>BJOG : an international journal of obstetrics and gynaecology</jtitle><addtitle>BJOG</addtitle><date>2021-09</date><risdate>2021</risdate><volume>128</volume><issue>10</issue><spage>1635</spage><epage>1644</epage><pages>1635-1644</pages><issn>1470-0328</issn><eissn>1471-0528</eissn><abstract>Objective
To determine the optimal total serum bile acid (TSBA) threshold and sampling time for accurate intrahepatic cholestasis of pregnancy (ICP) diagnosis.
Design
Case–control, retrospective cohort studies.
Setting
Antenatal clinics, clinical research facilities.
Population
Women with ICP or uncomplicated pregnancies.
Methods
Serial TSBA measurements were performed pre‐/postprandially in 42 women with ICP or uncomplicated pregnancy. Third‐trimester non‐fasting TSBA reference ranges were calculated from 561 women of black, south Asian and white ethnicity. Rates of adverse perinatal outcomes for women with ICP but peak non‐fasting TSBA below the upper reference range limit were compared with those in healthy populations.
Main outcome measures
Sensitivity and specificity of common TSBA thresholds for ICP diagnosis, using fasting and postprandial TSBA. Calculation of normal reference ranges of non‐fasting TSBA.
Results
Concentrations of TSBA increased markedly postprandially in all groups, with overlap between healthy pregnancy and mild ICP (TSBA <40 μmol/l). The specificity of ICP diagnosis was higher when fasting, but corresponded to <30% sensitivity for diagnosis of mild disease. Using TSBA ≥40 μmol/l to define severe ICP, fasting measurements identified 9% (1/11), whereas non‐fasting measurements detected over 91% with severe ICP. The highest upper limit of the non‐fasting TSBA reference range was 18.3 µmol/l (95% confidence interval: 15.0–35.6 μmol/l). A re‐evaluation of published ICP meta‐analysis data demonstrated no increase in spontaneous preterm birth or stillbirth in women with TSBA <19 µmol/l.
Conclusions
Postprandial TSBA levels are required to identify high‐risk ICP pregnancies (TSBA ≥40 μmol/l). The postprandial rise in TSBA in normal pregnancy indicates that a non‐fasting threshold of ≥19 µmol/l would improve diagnostic accuracy.
Tweetable
Non‐fasting bile acids improve the diagnostic accuracy of intrahepatic cholestasis of pregnancy diagnosis.
Tweetable
Non‐fasting bile acids improve the diagnostic accuracy of intrahepatic cholestasis of pregnancy diagnosis.
This article includes Author Insights, a video available at https://vimeo.com/bjog/authorinsights16669</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>33586324</pmid><doi>10.1111/1471-0528.16669</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-7904-7933</orcidid><orcidid>https://orcid.org/0000-0002-6861-5779</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1470-0328 |
| ispartof | BJOG : an international journal of obstetrics and gynaecology, 2021-09, Vol.128 (10), p.1635-1644 |
| issn | 1470-0328 1471-0528 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2489601748 |
| source | Wiley Online Library Journals Frontfile Complete |
| subjects | Bile acids Cholestasis Clinical decision making Cohort analysis Diagnosis Fasting Gallbladder diseases Liver diseases liver diseases in pregnancy Medical diagnosis Pregnancy Premature birth |
| title | Re‐evaluating diagnostic thresholds for intrahepatic cholestasis of pregnancy: case–control and cohort study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-05T06%3A00%3A33IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Re%E2%80%90evaluating%20diagnostic%20thresholds%20for%20intrahepatic%20cholestasis%20of%20pregnancy:%20case%E2%80%93control%20and%20cohort%20study&rft.jtitle=BJOG%20:%20an%20international%20journal%20of%20obstetrics%20and%20gynaecology&rft.au=Mitchell,%20AL&rft.date=2021-09&rft.volume=128&rft.issue=10&rft.spage=1635&rft.epage=1644&rft.pages=1635-1644&rft.issn=1470-0328&rft.eissn=1471-0528&rft_id=info:doi/10.1111/1471-0528.16669&rft_dat=%3Cproquest_cross%3E2489601748%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2561405912&rft_id=info:pmid/33586324&rfr_iscdi=true |