Category: Clinical Obstetrics
Poster Session IV
To determine the association between proteinuria and intrahepatic cholestasis of pregnancy (IHCP), and whether proteinuria is associated with severe characteristics of IHCP and poor pregnancy outcomes.
Study Design:
A retrospective cohort study between Jan 2016 and June 2020. The study included all pregnant women at gestational age of 24-37 weeks who had been diagnosed with IHCP based on clinical presentation, elevated liver enzymes or elevated total bile acids and had completed a 24h protein collection. Nonparametric statistics were applied for analysis.
Results:
The study group included 188 pregnancies with proteinuria defined as 24H protein collection of ≥300 mg/day, and 164 cases without proteinuria. In the proteinuria group only 30 (15.9%) had either elevated systolic or diastolic blood pressure and fulfilled the criteria to PET. In the non-proteinuric group 21 (12.8%) were diagnosed with PIH. Demographic parameters were comparable between the groups (table 1). IHCP onset was earlier in patients with proteinuria compared to those without proteinuria (32w, IQR 29-34 vs. 36w, IQR 34-37; P=0.001), the median total bile acid levels and serum aminotransferase levels were both higher (P=0.001) (table 1). Although the median of maximal values of systolic and diastolic blood pressure (BP) were both higher in patients with proteinuria compared to those without proteinuria (127, IQR 120-137 vs. 124.5, IQR 119-133; P=0.031 for systolic BP respectively; and 79, IQR 74-86 vs. 76, IQR 68-83, P=0.001 for diastolic BP respectively), The percent of patients with elevated systolic BP (≥140) or diastolic BP (≥90) were comparable. The presence of proteinuria was associated with higher prevalence of preterm rupture of membranes, lower birthweight in grams and earlier gestational age at delivery (table 2).
Conclusion: The results of this study suggest that proteinuria, regardless of preeclampsia, is a clinical feature of IHCP and is associated with severe characteristics of IHCP and increased pregnancy complications. These associations seem to be independent of blood pressure elevation and preeclampsia development.
Hadel Watad, MD
Resident Physician
Sheba Medical Center
Ramat Gan, Tel Aviv, Israel
Aviran Ohayon, MD
Sheba Medical Center
Ramat Gan, HaMerkaz, Israel
Raanan Meyer, MD
Sheba Medical Center
Tel Aviv, Israel, Israel
Adiel Cohen, MD
Sheba Medical Center
Ramat Gan, Israel, Israel
Eran Kassif, MD
Sheba Medical Center
Ramat Gan, HaMerkaz, Israel
Rakefet Yoeli, MD
Sheba Medical Center
Kiriat Ono, Tel Aviv, Israel
Shali Mazaki-Tovi, Prof.
Sheba Medical Center
Tel Aviv, Israel, Israel