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Archives of Medical Science
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vol. 14
Clinical research

Could first- and second-trimester biochemical markers for Down syndrome have a role in predicting intrahepatic cholestasis of pregnancy?

Ahter Tanay Tayyar, Ahmet Tayyar, Tolga Atakul, Cigdem Abide Yayla, Cetin Kilicci, Ahmet Eser, Resul Karakus, Dilsat Herkiloglu, Cevat Rifat Cundubey, Mehmet Tayyar

Arch Med Sci 2018; 14, 4: 846–850
Online publish date: 2017/09/05
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The aim of this study is to compare first- and second-trimester Down syndrome biochemical screening markers in intrahepatic cholestasis of pregnancy (ICP) and normal pregnancies.

Material and methods
This observational case-control study was conducted at Health Sciences University Zeynep Kamil Maternity and Children’s Health Training and Research Hospital and the Department of Obstetrics and Gynecology at Erciyes University Medical Faculty during 2016–2017. The study included 165 patients, and consisted of 62 women who had been diagnosed with ICP (the ICP-diagnosed group) and 103 healthy pregnant women (the control group). First-trimester free β-human chorionic gonadotropin (β-hCG), pregnancy-associated plasma protein-A (PAPP-A) and second-trimester total β-hCG, estriol (E3), -fetoprotein (AFP), and inhibin A levels were compared between the two groups.

The mean patient age was 28.67 ±5.96 years, with no significant difference between the groups (p > 0.05). Average PAPP-A levels were significantly lower in the ICP-diagnosed group (p < 0.001). When the cut-off value for PAPP-A was taken as ≤ 0.93 multiple of median (MoM), the sensitivity and specificity values for ICP were 73.8% and 56.3%, respectively (95% CI, AUC ± SE: 0.663 ±0.042).

The decrease in PAPP-A MoM value indicates an increase in the risk of developing ICP, while changes in other markers were not sufficient to predict ICP.


intrahepatic cholestasis, pregnancy, Down syndrome biochemical screening markers

Kulhan M, Kulhan NG, Nayki U, Nayki C, Ata N. Intrahepatic cholestasis of pregnancy and fetal outcomes. Mini review. Arch Med Sci Civil Dis 2017; 2: e85-6.
Williamson C, Geenes V. Intrahepatic cholestasis of pregnancy. Obstet Gynecol 2014; 124: 120-33.
Ozkan S, Ceylan Y, Ozkan OV, et al. Review of a challenging clinical issue: intrahepatic cholestasis of pregnancy. World J Gastroenterol 2015; 21: 7134-41.
Tayyar A, Temel Yuksel I, et al. Maternal copeptin levels in intrahepatic cholestasis of pregnancy. J Matern Fetal Neonatal Med 2017 Jun 14 :1-5. doi: 10.1080/14767058.2017.1335708.
Geenes V, Chappell LC, Seed PT, et al. Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: a prospective population-based case-control study. Hepatology 2014; 59: 1482-91.
Sugino N, Takiguchi S, Umekawa T, et al. Oxidative stress and pregnancy outcome: a workshop report. Placenta Netherlands 2007; 28: 48-50.
Karaahmet E, Ay Gungor ANC, Topaloglu N, Sahin B, Kivrak Y. Prevalence of psychiatric disorders during pregnancy and their effect on birth weight. Arch Med Sci Civil Dis 2016; 1: e24-9.
Arrese M, Macias RIR, Briz O, et al. Molecular pathogenesis of intrahepatic cholestasis of pregnancy. Expert Rev Mol Med 2008; 10: e9.
Hancerliogullari N, Aktulay A, Engin-Ustun Y, et al. Pregnancy-associated plasma protein a levels are decreased in obstetric cholestasis. Clin Exp Obstet Gynecol 2015; 42: 617-8.
Kang JH, Farina A, Park JH, et al. Down syndrome biochemical markers and screening for preeclampsia at first and second trimester: correlation with the week of onset and the severity. Prenat Diagn 2008; 28: 704-9.
Gutaj P, Wender-Ożegowska E, Brązert J. Maternal lipids associated with large-for-gestational-age birth weight in women with type 1 diabetes: results from a prospective single-center study. Arch Med Sci 2017; 13: 753-9.
Goetzinger KR, Cahill AG, Macones GA, et al. Association of first-trimester low PAPP-A levels with preterm birth. Prenat Diagn 2010; 30: 309-13.
Bacq Y, Sapey T, Brechot MC, et al. Intrahepatic cholestasis of pregnancy: a French prospective study. Hepatology 1997; 26: 358-64.
Roncaglia N, Locatelli A, Arreghini A, et al. A randomised controlled trail of ursodeoxycholic acid and S-adenosyl-1-methionine in the treatment of gestational cholestasis. BJOG 2004; 111: 17-21.
Kenyon AP, Piercy CN, Girling J, et al. Obstetric cholestasis, outcome with active management: a series of 70 cases. BJOG 2002; 109: 282-8.
Handschuh K, Guibourdenche J, Guesnon M, et al. Modulation of PAPP-A expression by PPARgamma in human first trimester trophoblast. Placenta 2006; 27 Suppl A: S127-34.
Bowman CJ, Streck RD, Chapin RE. Maternal-placental insulin-like growth factor (IGF) signaling and its importance to normal embryo-fetal development. Birth Defects Res B Dev Reprod Toxicol 2010; 89: 339-49.
Chełchowska M, Gajewska J, Mazur J, et al. Serum pregnancy-associated plasma protein A levels in the first, second and third trimester of pregnancy: relation to newborn anthropometric parameters and maternal tobacco smoking. Arch Med Sci 2016; 12: 1256-62.
Gagnon A, Wilson RD, Audibert F, et al. Obstetrical complications associated with abnormal maternal serum markers analytes. J Obstet Gynaecol Can 2008; 30: 918-49.
Kawamura I, Takeshita S, Fushimi M, et al. Stimulation of choleresis by insulin-like growth factor-I in rats. Endocr J 2000; 47: 249-55.
Mabuchi M, Kawamura I, Fushimi M, et al. Choleretic actions of insulin like growth factor I, prednisolone, and ursodeoxycholic acid in rats. Dig Dis Sci 2003; 48: 1398-405.
Ustun Y, Engin-Ustun Y, Ozturk O, et al. Ischemia modified albumin as an oxidative stress marker in preeclampsia. J Matern Fetal Neonatal Med 2011; 24: 418-21.
Ma SG, Yu WN, Jin Y, et al. Evaluation of serum ischemia-modified albumin levels in pregnant women with and without gestational diabetes mellitus. Gynecol Endocrinol. 2012; 28: 837-40.
Raty R, Anttila L, Virtanen A, et al. Maternal midtrimester free beta-HCG and AFP serum levels in spontaneous singleton pregnancies complicated by gestational diabetes mellitus, pregnancy-induced hypertension or obstetric cholestasis. Prenat Diagn 2003; 23: 1045-8.
Hagenbuch B, Dawson P. The sodium bile salt cotransport family SLC10. Pflugers Arch 2004; 447: 566-70.
Vallejo M, Briz O, Serrano MA, et al. Potential role of trans-inhibition of the bile salt export pump by progesterone metabolites in the etiopathogenesis of intrahepatic cholestasis of pregnancy. J Hepatol 2006; 44: 1150-7.
Glantz A, Reilly SJ, Benthin L, et al. Intrahepatic cholestasis of pregnancy: Amelioration of pruritus by UDCA is associated with decreased progesterone disulphates in urine. Hepatology 2008; 47: 544-51.
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