Intrahepatic cholestasis of pregnancy can increase the risk of metabolic disorders: A meta-analysis

Excessive bile acids level predisposes to adverse perinatal outcomes in women with abnormal pre-pregnancy body mass index

BACKGROUND

Both low/high pre-pregnancy body mass index (BMI) and increased bile acid levels during pregnancy (known as gestational hypercholanemia) were risk factors for adverse pregnancy outcomes, with limited information on their joint effects.

METHODS

A total of 63,066 pregnant women were involved in a large retrospective cohort study from May 2014 to December 2018 in Shanghai, China. Data of pregnancy outcomes including hypercholanemia, hypertensive disorders in pregnancy (HDP), preterm delivery, and small for gestation age (SGA), were obtained for multivariable logistic analysis.

RESULTS

Pre-pregnancy BMI was negatively associated with serum total bile acid (TBA) concentrations during gestation and the risk of hypercholanemia (p < 0.001). Low pre-pregnancy BMI and hypercholanemia coexisting were related to a 2.71-fold risk (95% confidence intervals [CI], 2.10-3.50) of SGA. Whereas, overweight/obese (OWO) with hypercholanemia are associated with 5.34-fold risk (95% CI 3.93-7.25) of HDP when compared with normal weight women without hypercholanemia. Women with excessive gestational weight gain (GWG) and hypercholanemia had a higher risk of HDP (odds ratio [OR] 3.56, 95% CI 2.91-4.36), and macrosomia (OR 2.95, 95% CI 2.42-3.60), compared with non-hypercholanemia women with adequate GWG. Whereas, women with inadequate GWG and hypercholanemia had increased risks of preterm delivery (OR 1.87, 95% CI 1.44-2.43), and SGA (OR 2.32, 95% CI 1.82-2.96).

CONCLUSIONS

Low maternal BMI before pregnancy was an independent risk factor for hypercholanemia. Additionally, pre-pregnancy underweight or OWO may amplify the effect of hypercholanemia on adverse pregnancy outcomes. Thus, pre-pregnancy BMI should be considered in the management of adverse perinatal outcomes related to gestational hypercholanemia.

Intrahepatic cholestasis of pregnancy and gestational diabetes: Protocol for a scoping review of associations, risk factors, and outcomes

BACKGROUND

Intrahepatic cholestasis of pregnancy (IHCP) is a pregnancy-related liver disease associated with adverse pregnancy outcomes, including spontaneous preterm labour, fetal hypoxia, meconium-stained liquor and intrauterine death. In women with IHCP, comorbidities may be associated with a greater risk of stillbirth. Recent studies have suggested that cholestasis of pregnancy may be associated with Gestational Diabetes Mellitus (GDM).

OBJECTIVE

This scoping review aims to comprehensively investigate the nature and strength of the association between Intrahepatic Cholestasis of Pregnancy (IHCP) and Gestational Diabetes Mellitus (GDM). The review also seeks to identify common risk factors contributing to the association and explore potential adverse effects associated with the concurrent presence of IHCP and GDM. The findings will inform clinical practice and guide future research initiatives in understanding and managing these pregnancy-related conditions.

METHODS

The scoping review followed the guidelines of Arksey, and O'Malley established in 2005, as well as modifications made to them by Levac et al. in 2010. The PRISMA Scoping review guidance shall be followed in reporting this study. Eight different databases are proposed to search, including Google Scholar, PubMed, Cochrane, Scopus, Embase, CINAHL, the American Diabetes Association, and the Wiley Online Library. Additionally, focused searches within the American Journal of Obstetrics and Gynecology (AJOG) will be conducted, and citation pearl indexing performed.

Prevalence, risk factors, and adverse perinatal outcomes in Chinese women with preeclampsia: a large retrospective cohort study

BACKGROUND

Preeclampsia (PE) is the primary cause of maternal and neonatal morbidity and mortality. However, comprehensive studies on the related risk factors with PE and its effects on adverse perinatal outcomes are limited. This study aimed to evaluate the prevalence, risk factors, and adverse perinatal outcomes in Chinese women with preeclampsia.

METHODS

We conducted a retrospective cohort study from January 1, 2018, to December 31, 2019, which enrolled 38,496 women without preeclampsia (non-PE) and 1130 women with PE. Univariate and multivariate logistic regression models were used to determine the risk factors and adverse perinatal outcomes of PE.

RESULTS

Multivariate logistic regression models showed that maternal age > 35 years, pp-BMI overweight/obesity, excessive gestational weight gain, multiparity, twin pregnancy, IVF, cesarean section history, times of abortion history ≥ 2, GDM, and ICP were significantly associated with the risk of PE (all P < 0.05). Women with PE in singleton pregnancies were associated with an increased risk of maternal outcomes of cesarean section, and preterm birth, and a higher risk of neonatal outcomes of stillbirth, low birth weight, fetal distress, neonatal asphyxia, and neonatal unit admission, which were also observed in women with PE in twin pregnancies, except for stillbirth and neonatal asphyxia.

CONCLUSION

This study identified the risk factors and associated adverse perinatal outcomes of PE, which providing comprehensive evidence for clinicians to manage women at risk of PE.

Early-onset intrahepatic cholestasis of pregnancy increased the incidence of gestational diabetes mellitus: a retrospective cohort study

Background

Intrahepatic cholestasis of pregnancy (ICP) and gestational diabetes mellitus (GDM) are two common pregnancy complications that pose considerable health challenges. The interplay between these conditions is believed to significantly influence pregnancy outcomes, yet the nature of this relationship remains elusive. This study was designed to elucidate the connection between ICP and GDM.

Methods

This retrospective cohort study included 742 singleton pregnancies delivered at the Shanghai Public Health Clinical Center from January 2015 to December 2023. We compared the incidence of GDM and pregnancy outcomes between multiple ICP subgroups and a control group of healthy pregnancies. A multivariate regression model was used to measure the independent association between ICP and propensity for GDM development, as well as to assess the impact of potential bidirectional effects between ICP and GDM.

Results

The results indicate that the incidence of GDM is highest in the early-onset ICP (diagnosed before the 24th week of gestation) group compared to the control group and other ICP subgroups. Early-onset ICP is an independent risk factor for the development of GDM, with other risk factors including age, history of abortion, family history of diabetes, and elevated ALT levels. Subgroup interaction analysis did not reveal heterogeneity in the influence of early-onset ICP on the development of GDM across different subgroups. Further analysis showed that GDM itself does not increase the risk of late-onset ICP. Additionally, when comparing pregnancy outcomes between GDM patients with or without ICP, those with both GDM and ICP had significantly higher rates of preterm birth, cesarean section, and small for gestational age (SGA) compared to patients with GDM alone. Furthermore, elevated TBA levels (first diagnosed) of early-onset ICP patients were associated with an increased risk of GDM in a nonlinear fashion.

Conclusion

Our study indicated that early-onset ICP is significantly linked to an increased risk of GDM. Further research is warranted to explore the mechanisms behind this association and to develop strategies for early identification and intervention to mitigate GDM risk.

Screening Preeclampsia Genes and the Effects of CITED2 on Trophoblastic Function

Purpose

Preeclampsia (PE) is a serious complication of obstetrics and represents a significant challenge in terms of understanding its underlying mechanism. It has been shown that a number of disorders involve dysregulation of the CBP/p300-interacting transactivator with glutamic acid/aspartic acid-rich carboxyl-terminal domain 2 (CITED2). However, the relationship between PE and CITED2 is still mostly unclear. This work aimed to confirm the hub genes linked to PE and explore the roles of CITED2 in trophoblast using experimental and bioinformatic methods.

Methods

To determine the hub genes, bioinformatics research was performed on two datasets from the Gene Expression Omnibus (GEO) public database. Immune infiltration analysis and enrichment analysis were also used to identify the related pathways and immune cells. PCR and WB were then used to validate the mRNA and protein levels of CITED2 in the PE samples. Finally, the expression of CITED2 was knocked down using siRNA to investigate the function of CITED2 in trophoblast development in vitro.

Results

The study's findings showed that the NOTCH signaling pathways, glycolysis, and hypoxia were the main areas of enrichment for the six PE-related genes that were tested. The results of immune infiltration suggest that activated NK cells and regulatory T cells may play an important role in this process. CITED2 was significantly upregulated in the PE placenta. In functional tests, the knockdown of CITED2 may enhance apoptosis while suppressing migration, invasion, and proliferation of cells.

Conclusion

This study offers important proof that CITED2 influences trophoblast cell function and may one day be a therapeutic target for PE.

Clinical and pathological characteristics of gestational diabetes mellitus with different insulin resistance

AIMS

To elucidate the clinical and pathological characteristics of gestational diabetes mellitus (GDM) with high and low insulin resistance.

METHODS

In total, 1393 GDM and 1001 non-GDM singleton deliveries were included in this study. Insulin resistance subtypes were classified according to the HOMA2-IR value. Clinical data were analyzed using SPSS 26.0. Placenta samples were collected for pathological analysis.

RESULTS

Maternal age and fasting glucose were identified as independent risk factors for GDM with high insulin resistance (p < 0.01), while fasting glucose was the sole risk factor for GDM with low insulin resistance (p < 0.001). Fetal distress was associated with both of GDM subtypes (both p < 0.01), while anemia, fetal growth restriction, large for gestational age and intrahepatic cholestasis in pregnancy were related to specific GDM insulin resistance subtype. In addition, GDM with high insulin resistance showed an increase of syncytial knots with down-regulation of PI3K/AKT signaling, while GDM with low insulin resistance showed normal syncytial knot counts and up-regulation of PI3K/AKT signaling.

CONCLUSIONS

Our findings provide novel perspectives to the clinical and pathological comprehensions of GDM with high and low insulin resistance, which might facilitate the mechanism study of GDM and its precision pregnancy management.

An omics review and perspective of researches on intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is one of the common pregnancy complications that may threaten the health of both pregnant women and their fetuses. Hence, it is of vital importance to identify key moleculars and the associated functional pathways of ICP, which will help us to better understand the pathological mechanisms as well as to develop precise clinical biomarkers. The emerging and developing of multiple omics approaches enable comprehensive studies of the genome, transcriptome, proteome and metabolome of clinical samples. The present review collected and summarized the omics based studies of ICP, aiming to provide an overview of the current progress, limitations and future directions. Briefly, these studies covered a broad range of research contents by the comparing of different experimental groups including ICP patients, ICP subtypes, ICP fetuses, ICP models and other complications. Correspondingly, the studied samples contain various types of clinical samples, in vitro cultured tissues, cell lines and the samples from animal models. According to the main research objectives, we further categorized these studies into two groups: pathogenesis and diagnosis analyses. The pathogenesis studies identified tens of functional pathways that may represent the key regulatory events for the occurrence, progression, treatment and fetal effects of ICP. On the other hand, the diagnosis studies tested more than 40 potential models for the early-prediction, diagnosis, grading, prognosis or differential diagnosis of ICP. Apart from these achievements, we also evaluated the limitations of current studies, and emphasized that many aspects of clinical characteristics, sample processing, and analytical method can greatly affect the reliability and repeatability of omics results. Finally, we also pointed out several new directions for the omics based analyses of ICP and other perinatal associated conditions in the future.

Interactive effects of gestational diabetes mellitus and maximum level of total bile acid in maternal serum on adverse pregnancy outcomes in women with intrahepatic cholestasis of pregnancy

OBJECTIVE

To study the combined effect of gestational diabetes mellitus (GDM) and maximum level of maternal serum total bile acid (TBA) on the incidence of adverse pregnancy outcomes in women with intrahepatic cholestasis of pregnancy (ICP).

METHODS

This was an observational study with 724 women with ICP. Perinatal outcomes were compared by the presence of GDM. Logistic regression was used to assess the independent and multiplicative interactions of GDM and maximum maternal serum TBA on adverse pregnancy outcomes. Additive interactions were calculated using an Excel sheet developed by Andersson to calculate relative excess risks.

RESULTS

The incidence of GDM in patients with ICP was 21.55%. Maternal age, pre-pregnancy weight, parity, and gravidity were positively correlated with GDM. Hypertensive disorders of pregnancy (HDP) and fetal distress rates were higher in the GDM vs. non-GDM group. There were no significant differences in biochemical outcomes (i.e., Triglyceride (TG), low density lipoprotein (LDL), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bile acid (TBA)) between the two groups. In terms of adverse pregnancy outcomes, GDM was only associated with maximum TBA concentration for cesarean section. No additive or pairwise interactions were detected between GDM and maximum TBA concentration and HDP, PPH, preterm delivery, LGA, SGA, and cesarean section.

CONCLUSION

GDM independently contributes to adverse pregnancy outcomes among women with ICP. However, the combined effects of GDM and maximum TBA concentration on adverse pregnancy outcomes do not appear to be multiplicative or additive.