Robert M Silver1, Corette B Parker2, Robert Goldenberg3, Uma M Reddy4, Donald J Dudley5, George R Saade6, Carol J Rowland Hogue7, Donald Coustan8, Michael W Varner9, Matthew A Koch2, Deborah Conway5, Radek Bukowski6, Halit Pinar10, Barbara Stoll11, Janet Moore2, Marian Willinger4. 1. Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT. Electronic address: bsilver@hsc.utah.edu. 2. RTI International, Research Triangle Park, NC. 3. College of Physicians and Surgeons, Department of Obstetrics and Gynecology, Columbia University, New York, NY. 4. Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD. 5. University of Texas Health Science Center at San Antonio, San Antonio, TX. 6. Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, TX. 7. Rollins School of Public Health, Emory University, Atlanta, GA. 8. Department of Obstetrics and Gynecology, Alpert Medical School, Brown University, Providence, RI. 9. Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT. 10. Department of Pathology, Alpert Medical School, Brown University, Providence, RI. 11. Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
Abstract
OBJECTIVE: We sought to compare bile acids in women with and without stillbirth in a population-based study. STUDY DESIGN: The Stillbirth Collaborative Research Network conducted a multisite, population-based case-control study of stillbirth (fetal deaths ≥20 weeks). Maternal sera were obtained at the time of enrollment and frozen at -80°C until assay for bile acids. RESULTS: Assays were performed in 581 women with stillbirth and 1546 women with live births. Bile acid levels were slightly higher in women with stillbirth (geometric mean [95% confidence interval {CI}] = 3.2 [3.0-3.5]) compared to live births (2.9 [2.7-3.1], P = .0327). However, the difference was not significant after adjustment for baseline risk factors for stillbirth. The proportion of women with elevated levels (≥10 or ≥40 μmol/L) was similar in stillbirths and live births. Results were similar when the analysis was limited to subsets of stillbirths and live births. In women with stillbirths not associated with fetal anomalies or obstetric complications bile acid levels were higher than in women with term live births (geometric mean [95% CI] = 3.4 [3.0-3.8] vs 2.9 [2.7-3.0], P = .0152, unadjusted; P = .06, adjusted). However, a similar proportion of women in both groups had levels ≥10 μmol/L (10.7 vs 7.2%; odds ratio [OR], 1.54; 95% CI, 0.97-2.44; adjusted OR, 1.29; 95% CI, 0.78-2.15) and ≥40 μmol/L (1.7 vs 0.7%; OR, 2.58; 95% CI, 0.85-7.84; adjusted OR, 2.28; 95% CI, 0.79-6.56). CONCLUSION: Our data do not support testing for bile acids in cases of stillbirth in the absence of clinical evidence of intrahepatic cholestasis of pregnancy.
OBJECTIVE: We sought to compare bile acids in women with and without stillbirth in a population-based study. STUDY DESIGN: The Stillbirth Collaborative Research Network conducted a multisite, population-based case-control study of stillbirth (fetal deaths ≥20 weeks). Maternal sera were obtained at the time of enrollment and frozen at -80°C until assay for bile acids. RESULTS: Assays were performed in 581 women with stillbirth and 1546 women with live births. Bile acid levels were slightly higher in women with stillbirth (geometric mean [95% confidence interval {CI}] = 3.2 [3.0-3.5]) compared to live births (2.9 [2.7-3.1], P = .0327). However, the difference was not significant after adjustment for baseline risk factors for stillbirth. The proportion of women with elevated levels (≥10 or ≥40 μmol/L) was similar in stillbirths and live births. Results were similar when the analysis was limited to subsets of stillbirths and live births. In women with stillbirths not associated with fetal anomalies or obstetric complicationsbile acid levels were higher than in women with term live births (geometric mean [95% CI] = 3.4 [3.0-3.8] vs 2.9 [2.7-3.0], P = .0152, unadjusted; P = .06, adjusted). However, a similar proportion of women in both groups had levels ≥10 μmol/L (10.7 vs 7.2%; odds ratio [OR], 1.54; 95% CI, 0.97-2.44; adjusted OR, 1.29; 95% CI, 0.78-2.15) and ≥40 μmol/L (1.7 vs 0.7%; OR, 2.58; 95% CI, 0.85-7.84; adjusted OR, 2.28; 95% CI, 0.79-6.56). CONCLUSION: Our data do not support testing for bile acids in cases of stillbirth in the absence of clinical evidence of intrahepatic cholestasis of pregnancy.
Authors: Halit Pinar; Matthew A Koch; Hal Hawkins; Josefine Heim-Hall; Carlos R Abramowsky; Vanessa R Thorsten; Marshall W Carpenter; Hong Holly Zhou; Uma M Reddy Journal: Am J Perinatol Date: 2011-08-03 Impact factor: 1.862
Authors: Corette B Parker; Carol J R Hogue; Matthew A Koch; Marian Willinger; Uma M Reddy; Vanessa R Thorsten; Donald J Dudley; Robert M Silver; Donald Coustan; George R Saade; Deborah Conway; Michael W Varner; Barbara Stoll; Halit Pinar; Radek Bukowski; Marshall Carpenter; Robert Goldenberg Journal: Paediatr Perinat Epidemiol Date: 2011-07-28 Impact factor: 3.980
Authors: Richard H Lee; Kay May Kwok; Sue Ingles; Melissa L Wilson; Patrick Mullin; Marc Incerpi; Bhuvan Pathak; T Murphy Goodwin Journal: Am J Perinatol Date: 2008-05-28 Impact factor: 1.862
Authors: J C Carey; M A Klebanoff; J C Hauth; S L Hillier; E A Thom; J M Ernest; R P Heine; R P Nugent; M L Fischer; K J Leveno; R Wapner; M Varner Journal: N Engl J Med Date: 2000-02-24 Impact factor: 91.245
Authors: J W Nijkamp; N J Sebire; K Bouman; F J Korteweg; J J H M Erwich; S J Gordijn Journal: Semin Fetal Neonatal Med Date: 2017-03-18 Impact factor: 3.926