Abnormal levels of certain fatty molecules, or lipids, in the blood appear to increase the risk of intrahepatic cholestasis of pregnancy (ICP) and its associated complications, according to a study conducted in China. The research also found that elevated levels of lipid-digesting bile acids in the bloodstream, a recognized diagnostic biomarker for ICP, correlated with significant changes in blood lipids, further supporting the potential of lipids as a biomarker.
“In clinical practice, bile acid and blood lipid levels in pregnant women should be closely monitored to improve the diagnosis and early prevention of ICP,” the researchers stated. “This may enhance both maternal and neonatal outcomes.”
Published in the Journal of Obstetrics and Gynaecology, the study investigated the correlation between blood lipids and intrahepatic cholestasis syndrome during pregnancy. The bile ducts, which transport bile from the liver to the small intestine for fat digestion and absorption, can become obstructed in cholestasis. This obstruction results in bile accumulating in the liver and leaking into the bloodstream.
Understanding ICP
Intrahepatic cholestasis of pregnancy is a condition that can develop in the later stages of pregnancy. While symptoms typically resolve after childbirth, ICP poses risks for both mothers and their babies. The condition is commonly diagnosed through blood tests that measure high levels of bile acids and assess liver function based on liver enzyme levels.
However, researchers noted that some women diagnosed with ICP do not exhibit elevated total bile acid (TBA) levels, and other medical conditions can also lead to increased TBA levels.
Bile acid levels are closely linked to lipid metabolism, absorption, and regulation—particularly concerning cholesterol, which is metabolized into bile acids in the liver. This relationship underscores the connection between bile acid and blood lipid levels.
The Study’s Findings
To investigate the potential of blood lipids as early biomarkers for ICP, researchers analyzed the medical records of 473 pregnant women aged 20-40, all in the later stages of pregnancy, who visited a single hospital in China from June 2020 to June 2023. Among these women, 204 had ICP while 269 did not.
The results indicated that women with ICP had significantly higher levels of low-density lipoprotein (LDL, often referred to as “bad” cholesterol), total cholesterol, apolipoprotein B (APOB), and triglycerides compared to those without ICP. Conversely, the ICP group exhibited significantly lower levels of apolipoprotein A (APOA) and a diminished ratio of high-density lipoprotein (HDL, known as “good” cholesterol) to LDL, as well as a lower ratio of APOA to APOB.
Significant associations were also found between these lipid levels and liver enzymes and bile acids. Notably, the APOA/APOB ratio demonstrated the best predictive capability for differentiating between women with and without ICP. A cutoff value of 1.4781 yielded a sensitivity of 85.9% and specificity of 47.5% for correctly identifying ICP cases.
Independent Risk Factors for ICP
Further statistical analyses revealed that even after accounting for potential confounding factors, including age, all lipid levels and ratios remained independent risk factors for ICP.
Among women with ICP, those with gestational diabetes—a condition characterized by high blood sugar during pregnancy—had significantly lower HDL levels than those without. Additionally, women with hypothyroidism exhibited significantly lower APOA levels.
Women with ICP and preeclampsia—marked by high blood pressure—had notably higher triglyceride levels, while those who experienced preterm delivery (before 37 weeks of pregnancy) had significantly lower HDL and APOA blood levels.
The study also linked higher bile acid blood levels to gestational diabetes, hypothyroidism, and preterm delivery, suggesting a connection between bile acids and altered blood lipid levels.
The researchers concluded, “We found that patients with ICP who have higher bile acid levels tend to experience more disrupted lipid metabolism, alongside a higher risk of complications and adverse pregnancy outcomes. These findings have clinical significance, indicating that monitoring changes in blood lipids can help reduce the risk of complications associated with cholestasis during pregnancy.” They emphasized the importance of effective treatment for affected patients.
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