This article is more than 5 years old. Information may no longer be current.
Intrahepatic cholestasis of pregnancy linked to glucose intolerance, dyslipidemia
Click Here to Manage Email Alerts
Impaired glucose tolerance, dyslipidemia and increased fetal growth are all associated with intrahepatic cholestasis of pregnancy, according to recent study findings published in Diabetes Care.
Catherine Williamson, MD, FRCP, of Imperial College London, and colleagues evaluated 26 women with intrahepatic cholestasis of pregnancy (ICP), as well as 27 women with healthy pregnancies (controls), to determine the differences of changes in glucose and lipid concentrations between the two groups. Researchers also evaluated the effect of ICP on fetal growth.
The ICP group had significantly higher serum bile acids (P≤.005) and alanine transaminase (P≤.005) compared with controls.
Overall, 19 participants from the ICP group and 23 controls had their ambulatory glycemic profiles assessed. Compared with controls, the ICP group had a higher blood glucose concentration over time, which remained even after adjustment for maternal age, BMI, parity and ethnicity (P<.005).
The ICP group had significantly higher maternal peak postprandial glucose concentrations compared with controls (P≤.005) and lower average ambulatory energy expenditure recorded by the pedometer (P=.06); however, the ICP group had higher overall blood glucose concentrations (P=.028).
Twenty-three participants from the ICP group and 24 controls underwent glucose tolerance testing that revealed a 30% incidence of gestational diabetes among the ICP group (P≤.005).
Fasting total cholesterol, LDL cholesterol and serum triglycerides were all higher among the ICP group compared with controls, and HDL cholesterol was reduced.
No significant difference was found for mean birth weight of singleton births among the groups (P=.54); however, compared with controls, births among the ICP group had higher birth weight centiles.
“[Gestational diabetes] also occurs more commonly in pregnancies complicated by ICP,” the researchers wrote. “It is plausible that the mechanism underlying our findings is attenuated activity of the bile acid receptors FXR and TGR5, which resolves following the fall in sulfated progesterones and/or estrogens at delivery. Of concern is the potential influence that these changes may have on the long-term morbidity of the offspring of affected mothers. Given the growing evidence in support of an association between ICP and [gestational diabetes], the authors advocate a low threshold for screening women with new-onset cholestasis for impaired glucose tolerance. Further work is required to help clarify which metabolic pathways are altered in ICP in order to better promote both maternal and fetal well-being.”
Disclosure: See the full study for a complete list of the researchers’ relevant financial disclosures.
Click Here to Manage Email Alerts