Imperial College London
Alternate

ProfessorJulianWalters

Faculty of Medicine, Department of Metabolism, Digestion and Reproduction

Professor of Gastroenterology
 
 
 
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Contact

 

+44 (0)20 3313 2361julian.walters

 
 
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Location

 

Rm368, Hammersmith HouseHammersmith HospitalHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Mitchell:2021:10.1111/1471-0528.16669,
author = {Mitchell, AL and Ovadia, C and Syngelaki, A and Souretis, K and Martineau, M and Girling, J and Vasavan, T and Fan, HM and Seed, PT and Chambers, J and Walters, JRF and Nicolaides, K and Williamson, C},
doi = {10.1111/1471-0528.16669},
journal = {BJOG},
title = {Re-evaluating diagnostic thresholds for intrahepatic cholestasis of pregnancy: case-control and cohort study.},
url = {http://dx.doi.org/10.1111/1471-0528.16669},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - 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-/post-prandially 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 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: TSBA concentrations increased markedly postprandially in all groups, with overlap between healthy pregnancy and mild ICP (TSBA<40μmol/L). The specificity of ICP diagnosis was higher when fasting, however, corresponded to <30% sensitivity for diagnosis of mild disease. Using TSBA ≥40μmol/L to define severe ICP, fasting measurements identified 9% (1/11), while non-fasting measurements detected over 91% with severe ICP. The highest upper limit of the non-fasting TSBA reference range was 18.3µmol/L (95% confidence interval 15.0 to 35.6μmol/L). A re-evaluation of published ICP meta-analysis data demonstrated no increase in spontaneous preterm birth or stillbirth in women with TSBA <19µmol/L. CONCLUSIONS: Postprandial TSBA levels are required to identify high-risk ICP pregnancies (TSBA≥40μmol/L). The postprandial TSBA rise in normal pregnancy indicates that a non-fasting threshold of ≥19µmol/L would improve diagnostic accuracy.
AU  - Mitchell,AL
AU  - Ovadia,C
AU  - Syngelaki,A
AU  - Souretis,K
AU  - Martineau,M
AU  - Girling,J
AU  - Vasavan,T
AU  - Fan,HM
AU  - Seed,PT
AU  - Chambers,J
AU  - Walters,JRF
AU  - Nicolaides,K
AU  - Williamson,C
DO  - 10.1111/1471-0528.16669
PY  - 2021///
TI  - Re-evaluating diagnostic thresholds for intrahepatic cholestasis of pregnancy: case-control and cohort study.
T2  - BJOG
UR  - http://dx.doi.org/10.1111/1471-0528.16669
UR  - https://www.ncbi.nlm.nih.gov/pubmed/33586324
ER  -
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