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Prospective observational comparative study of association of intrahepatic cholestasis in pregnancy with gestational diabetes mellitus

Author: 
Dr. Pravesh Kumari, Dr. Pushpa Nagar, Dr. Mahima Sharma and Dr. Munmun Yadav
Subject Area: 
Health Sciences
Abstract: 

Introduction: Intrahepatic cholestasis of pregnancy (ICP) is a most common pregnancy-related liver disorder. It frequently develops in late pregnancy. It is associated with increased rates of maternal and foetal adverse outcomes including spontaneous preterm labour, foetal hypoxia, meconium-stained liquor and stillbirth. It is therefore essential to increase interest in knowledge of the disease and to find a safe medical treatment that improve foetal outcomes. Aims and Objectives: This study aims to determine the association between ICP with gestational diabetes mellitus (GDM). Material & Methods: It was a prospective observational comparative study conducted in the Department of OBG S.M.S. Medical college Jaipur from June 2018 to July 2019. Two groups with 30 patients in each group were included in this study. Cases were diagnosed by h/o pruritus at 24 weeks and above and controls were without h/o ICP. Both groups were subjected to DIPSI testing. Results were tabulated and statically analysed by using SPSS software. Results: ICP women were belonging to mean age group of 22.2 ± 1.85 years. Serum bile acid was found to be significantly higher in ICP group (35.97 ± 26.47) compared to control subjects (4.19 ± 0.84 µmol /L) with p <0.001. Mean DIPSI was higher in intra hepatic cholestasis cases (153.4 ± 44.6 mg/dl) as compared to controls (118.2 ± 40.9 mg/dl) and statistically significant (p=0.002). Conclusion: ICP is characterized by glucose intolerance and dyslipidaemia, consistent with the changes seen in the metabolic syndrome. GDM also occurs more commonly in pregnancies complicated by ICP. Given the growing evidence in support of an association between ICP and GDM, Further work is required to help clarify which metabolic pathways are altered in ICP in order to better promote both maternal and fetal well-being.

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