Bile acids in a multicenter, population-based case-control study of stillbirth.
OBJECTIVE
We sought to compare bile acids in women with and without stillbirth in a population-based study.


METHODS
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).


CONCLUSIONS
Our data do not support testing for bile acids in cases of stillbirth in the absence of clinical evidence of intrahepatic cholestasis of pregnancy.
Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT. Electronic address: bsilver@hsc.utah.edu.
Robert M
RM
Silver
RTI International, Research Triangle Park, NC.
Corette B
CB
Parker
College of Physicians and Surgeons, Department of Obstetrics and Gynecology, Columbia University, New York, NY.
Robert
R
Goldenberg
Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
Uma M
UM
Reddy
University of Texas Health Science Center at San Antonio, San Antonio, TX.
Donald J
DJ
Dudley
Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, TX.
George R
GR
Saade
Rollins School of Public Health, Emory University, Atlanta, GA.
Carol J Rowland
CJ
Hogue
Department of Obstetrics and Gynecology, Alpert Medical School, Brown University, Providence, RI.
Donald
D
Coustan
Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT.
Michael W
MW
Varner
RTI International, Research Triangle Park, NC.
Matthew A
MA
Koch
University of Texas Health Science Center at San Antonio, San Antonio, TX.
Deborah
D
Conway
Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, TX.
Radek
R
Bukowski
Department of Pathology, Alpert Medical School, Brown University, Providence, RI.
Halit
H
Pinar
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
Barbara
B
Stoll
RTI International, Research Triangle Park, NC.
Janet
J
Moore
Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
Marian
M
Willinger
D000328:Adult; D001647:Bile Acids and Salts / Q000097:blood*; D016022:Case-Control Studies; D002780:Cholestasis, Intrahepatic / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005313:Fetal Death / Q000097:blood*; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology; D047929:Term Birth / Q000097:blood; D055815:Young Adult
D001647:Bile Acids and Salts
bile acids; cholestasis; stillbirth