Is increased maternal endothelin-1 concentration associated with neonatal asphyxia and preterm delivery in intrahepatic cholestasis of pregnancy?
OBJECTIVE
To evaluate plasma endothelin-1 (ET-1) and fetuin-A concentrations in women with intrahepatic cholestasis of pregnancy (ICP) and to determine whether there is any association between these parameters and fetal asphyxia.


METHODS
We carried out a prospective case-control study consisting of 32 women with ICP at third trimester of pregnancy and 32 pregnant women without ICP. Blood samples from maternal peripheral venous circulation were collected and ET-1 and fetuin-A levels were determined from the plasma samples. Pulse-wave Doppler and Apgar scores were also recorded.


RESULTS
ET-1 concentrations were significantly higher in ICP patients. No difference was observed in fetuin-A levels between the two groups. Six newborns were declared as asphyctic (APGAR score at the 5 min <7). Maternal ET-1 levels did not correlate with the APGAR score at 5 min, total bile acid (TBA) and umbilical artery systolic/diastolic ratio with ICP patients. TBA levels were positively correlated with umbilical artery systolic/diastolic ratio negatively correlated with APGAR score at the 1' and 5'-Apgar score in all subjects. Plasma ET-1 concentration was higher in the preterm neonates of mothers with ICP compared with normal term neonates of mothers.


CONCLUSIONS
Although these data did not show evidence that maternal ET-1 would be associated with fetal distress, we can speculate that maternal ET-1 may be playing a role in the underlying pathology regarding microvascular dysfunction especially in the preterm neonates of mothers with ICP. Elevated TBA levels may increase the risk of asphyxia whereas fetuin-a (as an anti-inflammation marker) does not seem to have effect in women with ICP.
Izmir Aegean Obstetrics and Gynecology Teaching Hospital, Izmir, Turkey.
Ayse Gul
AG
Kebapcilar
Levent
L
Kebapcilar
Cuneyt Eftal
CE
Taner
Giray
G
Bozkaya
Gulcin
G
Sahin
Sevki Goksun
SG
Gokulu
D000293:Adolescent; D000328:Adult; D001034:Apgar Score; D001238:Asphyxia Neonatorum / Q000097:blood* / Q000209:etiology; D001798:Blood Proteins / Q000378:metabolism*; D016022:Case-Control Studies; D002780:Cholestasis, Intrahepatic / Q000097:blood* / Q000150:complications; D019332:Endothelin-1 / Q000097:blood*; D005260:Female; D005316:Fetal Distress / Q000097:blood / Q000209:etiology; D006801:Humans; D007231:Infant, Newborn; D017078:Laser-Doppler Flowmetry; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood*; D047928:Premature Birth / Q000097:blood / Q000209:etiology; D011446:Prospective Studies; D014469:Umbilical Arteries / Q000098:blood supply; D055815:Young Adult; D060749:alpha-2-HS-Glycoprotein
C556354:AHSG protein, human; D001798:Blood Proteins; D019332:Endothelin-1; D060749:alpha-2-HS-Glycoprotein