Epidemiology

Intrahepatic cholestasis of pregnancy increases neonatal respiratory distress risk

Last Updated: 2006-05-03 9:53:33 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Intrahepatic cholestasis of pregnancy (ICP) increases the risk of respiratory distress syndrome (RDS) in the newborn, according to a report in the May issue of Pediatrics.

"Neonatologists should give particular attention during the first hours of life to these babies, monitoring respiratory function if they are delivered before term or near term (even at 37 - 38 weeks of gestation)," Dr. Enrico Zecca from Catholic University of the Sacred Heart, Rome, told Reuters Health.

Dr. Zecca and colleagues investigated the incidence of neonatal RDS after pregnancies complicated by ICP and measured bile acid levels in the affected mothers and their infants.

The incidence of RDS was about twice as high in infants of mothers with ICP (28.6%) as in infants of mothers without ICP (14.1%), the authors report.

Low gestational age and male gender were also significantly associated with the occurrence of RDS, the results indicate.

Bile acid levels of mothers with ICP who delivered healthy infants did not differ significantly than those of mothers who delivered infants that developed RDS, the researchers note. Similarly, infants with RDS had bile acid levels that were similar to those of healthy infants.

Maternal and neonatal bile acid levels showed only a poor correlation, the report indicates, but the interval between the last maternal bile acid level and delivery had a wide range (from 1 day to 1 week).

The authors suggest that bile acids can produce surfactant depletion in the alveoli by reversing the reaction of phospholipase A2.

"Babies from mothers with ICP have a higher risk to develop neonatal RDS," Dr. Zecca concluded. "Obstetricians should take this into account when planning a preterm delivery in ICP pregnancies, and neonatologists should have particular clinical attention during the first hours of life."

Pediatrics 2006;117:1670-1673.