Can the Severity of Intrahepatic Cholestasis of Pregnancy Be Predicted by Second Trimester Screening Test Parameters

Abstract

Objective The second trimester triple test although declared inadequate for the screening of aneuploidies by the International Society for Prenatal Diagnosis remains a widely employed test. We aim to investigate the associations between the biochemical parameters of the triple test and the severity of intrahepatic cholestasis of pregnancy (ICP). Material and Methods The triple test parameters of 102 healthy pregnant women and 100 pregnant women with ICP were evaluated retrospectively. Serum bile acid level of >= 40 mu mol/L was categorized as severe ICP. Serum alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (beta-hCG), and unconjugated estriol (uE3) multiple of the median (MoM) values and the perinatal outcomes were recorded. The Student's t-test, Mann-Whitney U test, Kruskal-Wallis test, and receiver operating characteristic curve analysis were used to compare the data. Results The AFP, beta-hCG, and uE3 MoM values were higher in the severe ICP group when compared to those with mild ICP and those without ICP (p < 0.01). The sensitivity and specificity values for ICP were 80.95% and 73.42%, respectively, with AFP values >= 1.26 MoM, 76.19% and 88.61%, respectively, with beta-hCG values >= 1.78 MoM, and 61.90% and 94.94%, respectively, with uE3 values >= 1.58 MoM [95% confidence interval; area under the curve (AUC) +/- standard error (SE) = 0.810 +/- 0.049, AUC +/- SE: 0.790 +/- 0.065, and AUC +/- SE: 0.797 +/- 0.065, respectively]. Conclusion An increase in the AFP, beta-hCG, and uE3 MoM values in the triple test can predict the risk of developing severe ICP.