Is Fetal Lung Maturity Delayed in Patients With Severe Cholestasis of Pregnancy?

Author Type(s)

Faculty

Document Type

Abstract

Publication Date

2-2021

Journal Title

American Journal of Obstetrics and Gynecology

Department

Obstetrics and Gynecology

Abstract

Objective

With well documented higher rates of respiratory distress syndrome (RDS) in fetuses born to mothers with cholestasis, we set to determine if bile acid levels can serve as a predictor for delayed or accelerated lung maturity in patients with intrahepatic cholestasis of pregnancy.

Study Design

We followed 185 Hispanic patients with cholestasis of pregnancy who underwent amniocentesis at the preterm and early term periods between 2005-2014, to determine the presence or absence of fetal lung maturity, defined as Lecithin:Sphingomyelin >2.5, detectable Phosphatidylglycerol, lamellar body count of >50,000. We then compared the groups who underwent amniocentesis between 36.0-37.6 to identify the relationship between bile acid levels and fetal lung maturity.

Results

Out of the 185 patients with documented amniocentesis, 113 were performed between 36.0-37.6 weeks of gestation. When testing for lung maturity at that gestational age, there was no statistically significant difference between the positive and negative result groups with median of bile acids of 31.3 (21.6,44.5) and 34.9 (23.9,62.3) respectively (p=0.16). Logistic regression analysis was performed using predefined total bile acid cutoffs of 20 μmol/L, 30 μmol/L, 40μmol/L and 50 μmol/L. determined that bile acid levels did not correlated with a negative lung maturity test at time of amniocentesis when performed between 36.0-37.6. ROC curve using total BA was performed resulting in an AUC of 0.58 showing low clinical relevance.

Conclusion

Bile acid levels could not serve as a predictor for presence or absence of lung maturity determined by amniocentesis (performed between 36.0-37.6 weeks of gestation). Though certain pregnancy complications have shown to impact lung maturity, we could not identify a correlation between bile acid levels and an accelerated or delayed lung maturity process. It is therefore our recommendation that late preterm and early term delivery in the setting of cholestasis be preceded by amniocentesis in order to avoid iatrogenic respiratory distress syndrome in the neonate, which has been reported in the literature.

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