open access
Association between intrahepatic cholestasis in pregnancy and gestational diabetes mellitus. A retrospective analysis
Affiliations- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
open access
Abstract
Objectives: Intrahepatic cholestasis of pregnancy (ICP) is a liver specific disorder affecting 0.08%–27.6% pregnant women. It is characterized by reduced expression of the primary bile acid farnesoid receptor (FXR). In recent studies, it has been showed that FXR has an impact on normal glucose homeostasis. Based on that it was suggested that the level of bile acids correlates with glucose level. The aim of the study was to evaluate the association between ICP and gestational diabetes mellitus (GDM).
Material and methods: 102 singleton patients complicated by ICP were included to the study and divided into two groups: non-GDM group (74 patients) and GDM group (28 patients). ICP was diagnosed based on the serum bile acids level > 10 μmol/L and GDM with the 75 g oral glucose tolerance test and FIGO guidelines. Demographic and clinical outcome data (including maternal age, BMI and infant weight) and ICP and GDM biochemical markers were collected.
Results: The incidence of GDM in ICP patients was 27.45%. 73% of women included to the study developed mild cholestasis. Lower levels of serum bile acids were correlated with GDM group. When compared mean total bilirubin level was significantly higher in non-GDM group. Transaminases (ALT, AST) and neonate condition including mean birth weight revealed no significant difference between the groups. On the other hand, prevalence of large for gestational age was significantly higher in non-GDM group (p < 0.00001).
Conclusions: The incidence of ICP is higher in women with GDM.
Abstract
Objectives: Intrahepatic cholestasis of pregnancy (ICP) is a liver specific disorder affecting 0.08%–27.6% pregnant women. It is characterized by reduced expression of the primary bile acid farnesoid receptor (FXR). In recent studies, it has been showed that FXR has an impact on normal glucose homeostasis. Based on that it was suggested that the level of bile acids correlates with glucose level. The aim of the study was to evaluate the association between ICP and gestational diabetes mellitus (GDM).
Material and methods: 102 singleton patients complicated by ICP were included to the study and divided into two groups: non-GDM group (74 patients) and GDM group (28 patients). ICP was diagnosed based on the serum bile acids level > 10 μmol/L and GDM with the 75 g oral glucose tolerance test and FIGO guidelines. Demographic and clinical outcome data (including maternal age, BMI and infant weight) and ICP and GDM biochemical markers were collected.
Results: The incidence of GDM in ICP patients was 27.45%. 73% of women included to the study developed mild cholestasis. Lower levels of serum bile acids were correlated with GDM group. When compared mean total bilirubin level was significantly higher in non-GDM group. Transaminases (ALT, AST) and neonate condition including mean birth weight revealed no significant difference between the groups. On the other hand, prevalence of large for gestational age was significantly higher in non-GDM group (p < 0.00001).
Conclusions: The incidence of ICP is higher in women with GDM.
Keywords
gestational diabetes mellitus; intrahepatic cholestasis of pregnancy; bile acids; preterm delivery
About this articleTitle
Association between intrahepatic cholestasis in pregnancy and gestational diabetes mellitus. A retrospective analysis
Journal
Issue
Article type
Research paper
Pages
458-463
Published online
2019-08-30
Page views
3074
Article views/downloads
2614
DOI
Pubmed
Bibliographic record
Ginekol Pol 2019;90(8):458-463.
Keywords
gestational diabetes mellitus
intrahepatic cholestasis of pregnancy
bile acids
preterm delivery
Authors
Agata Majewska
Bartosz Godek
Dorota Bomba-Opon
Miroslaw Wielgos
References (24)- Geenes V, Williamson C. Intrahepatic cholestasis of pregnancy. World J Gastroenterol. 2009; 15(17): 2049–2066.
- Bain E, Crane M, Tieu J, et al. Diet and exercise interventions for preventing gestational diabetes mellitus. Cochrane Database Syst Rev. 2015(4): CD010443.
- Wan CS, Abell S, Aroni R, et al. Ethnic differences in prevalence, risk factors, and perinatal outcomes of gestational diabetes mellitus: A comparison between immigrant ethnic Chinese women and Australian-born Caucasian women in Australia. J Diabetes. 2019 [Epub ahead of print].
- Mirghani Dirar A, Doupis J. Gestational diabetes from A to Z. World J Diabetes. 2017; 8(12): 489–511.
- Abu-Hayyeh S, Papacleovoulou G, Lövgren-Sandblom A, et al. Intrahepatic cholestasis of pregnancy levels of sulfated progesterone metabolites inhibit farnesoid X receptor resulting in a cholestatic phenotype. Hepatology. 2013; 57(2): 716–726.
- Martineau MG, Raker C, Dixon PH, et al. The metabolic profile of intrahepatic cholestasis of pregnancy is associated with impaired glucose tolerance, dyslipidemia, and increased fetal growth. Diabetes Care. 2015; 38(2): 243–248.
- Zaręba-Szczudlik J, Pykało-Gawińska D, Stępień A, et al. Gestational diabetes mellitus (GDM) - do the number of fulfilled diagnostic criteria predict the perinatal outcome? Ginekol Pol. 2018; 89(7): 381–387.
- Moftakhar L, Solaymani-Dodaran M, Cheraghian B. Role of obesity in gestational hypertension in primigravidae women: A case control study in Shadegan, Iran. Med J Islam Repub Iran. 2018; 32: 104.
- Nowak M, Kalwa M, Oleksy P, et al. The relationship between pre-pregnancy BMI, gestational weight gain and neonatal birth weight: a retrospective cohort study. Ginekol Pol. 2019; 90(1): 50–54.
- Catalano PM, Shankar K. Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. BMJ. 2017; 356: j1.
- Najafi F, Hasani J, Izadi N, et al. The effect of prepregnancy body mass index on the risk of gestational diabetes mellitus: A systematic review and dose-response meta-analysis. Obes Rev. 2019; 20(3): 472–486.
- Radesky JS, Oken E, Rifas-Shiman SL, et al. Diet during early pregnancy and development of gestational diabetes. Paediatr Perinat Epidemiol. 2008; 22(1): 47–59.
- Forsum E, Brantsæter AL, Olafsdottir AS, et al. Weight loss before conception: A systematic literature review. Food Nutr Res. 2013; 57.
- Yogev Y, Langer O. Spontaneous preterm delivery and gestational diabetes: the impact of glycemic control. Arch Gynecol Obstet. 2007; 276(4): 361–365.
- Bar-Hava I, Barnhard Y, Scarpelli SA, et al. Gestational diabetes and preterm labour: is glycaemic control a contributing factor?. Eur J Obstet Gynecol Reprod Biol. 1997; 73(2): 111–114.
- Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015; 112(29-30): 489–495.
- Bacq Y, Sentilhes L. Intrahepatic cholestasis of pregnancy: Diagnosis and management. Clin Liver Dis (Hoboken). 2014; 4(3): 58–61.
- Grabowska K, Stapińska-Syniec A, Saletra A, et al. Labour in women with gestational diabetes mellitus. Ginekol Pol. 2017; 88(2): 81–86.
- Cypryk K, Szymczak W, Czupryniak L, et al. Gestational diabetes mellitus - an analysis of risk factors. Endokrynol Pol. 2008; 59(5): 393–397.
- Gao J, Xu B, Zhang X, et al. Association between serum bile acid profiles and gestational diabetes mellitus: A targeted metabolomics study. Clin Chim Acta. 2016; 459: 63–72.
- Prawitt J, Caron S, Staels B. Bile acid metabolism and the pathogenesis of type 2 diabetes. Curr Diab Rep. 2011; 11(3): 160–166.
- Trauner M, Claudel T, Fickert P, et al. Bile acids as regulators of hepatic lipid and glucose metabolism. Dig Dis. 2010; 28(1): 220–224.
- Martineau M, Raker C, Powrie R, et al. Intrahepatic cholestasis of pregnancy is associated with an increased risk of gestational diabetes. Eur J Obstet Gynecol Reprod Biol. 2014; 176: 80–85.
- Fisk N, Bye W, Storey G. Maternal Features of Obstetric Cholestasis: 20 Years Experience at King George V Hospital. The Australian and New Zealand Journal of Obstetrics and Gynaecology. 1988; 28(3): 172–176.
