Prevalence of gestational diabetes mellitus in intrahepatic cholestasis of pregnancy

Authors

  • Umaira Fathima R. M. Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital, New Delhi, India
  • Garima K. Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital, New Delhi, India
  • Sugandha Arya Department of Paediatrics, VMMC and Safdarjung Hospital, New Delhi, India
  • Roohat Parveen Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital, New Delhi, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20231235

Keywords:

Gestational diabetes mellitus, Intrahepatic cholestasis, Pregnancy

Abstract

Background: Incidence of IHCP in Indian population is 0.02%-2.4% and that of GDM is 3.8%-17.9%. Frequent co-existence of both has raised the question of any association. There exists only few studies to prove or disprove any association. Objective of current study was to determine the prevalence of GDM in women with IHCP and to compare the feto-maternal outcome in women with GDM with or without IHCP.

Methods: The study was conducted in the Department of Obstetrics and Gynaecology, VMMC and SJH, New Delhi. Women with singleton pregnancy ≥28wks were recruited for the study and further categorized as women with IHCP and women without IHCP according to their diagnosis of IHCP by the RCOG guidelines. OGTT with 75g glucose was done to make the diagnosis of GDM. Management was as per obstetrics protocol and feto-maternal outcomes recorded till delivery.

Results: No statistically significant difference in the prevalence of GDM observed in both groups (5.4% in women with IHCP and 8.2% in women without IHCP, p=0.220). Significantly higher number of preterm deliveries (21%, p<0.001), induced labour (53.6%, p<0.001), women undergoing LSCS (46.3%, p<0.001) in women with IHCP. No association of FGR, MSL, Fetal maturity, labour onset, mode of delivery, stillbirth, low APGAR score, NICU admission, or PPH in women with GDM with or without IHCP.

Conclusions: The prevalence of GDM is not higher in women with IHCP but significantly higher incidence of preterm delivery, induced labour, and Caesarean sections in women with IHCP. No significant difference in feto-maternal outcome in women with GDM with or without IHCP.

References

Williamson GC. Cholestasis of pregnancy. World J Gastroenterol. 2009;15(17):2049-66.

Ghosh S, Chaudhuri S. Intra-hepatic cholestasis of pregnancy: a comprehensive review. Indian J Dermatol. 2013;58(4):327

Menżyk T, Bator M, Derra A, Kierach R, Kukla M. The role of metabolic disorders in the pathogenesis of intrahepatic cholestasis of pregnancy. Clin Exper Hepatol. 2018;4(4):217-23.

Martineau M, Raker C, Dixon PH, Chambers J, Machirori M, King NM, et al. The metabolic profile of intrahepatic cholestasis of pregnancy is associated with impaired glucose tolerance, dyslipidemia, and increased fetal growth. Diab Care. 2015;38(2):243-8.

Bacq Y, Sapey T, Bréchot MC, Pierre F, Fignon A, Dubois F. Intrahepatic cholestasis of pregnancy: a French prospective study. Hepatol. 1997;26(2):358-64

Kauppila A, Korpela H, Mäkilä UM, Yrjänheikki E. Low serum selenium concentration and glutathione peroxidase activity in intrahepatic cholestasis of pregnancy. Br Med J. 1987;294(6575): 150-2.

Siddiqui S, Waghdhare S, Panda M, Sinha S, Singh P, Dubey S, et al. Regional prevalence of gestational diabetes mellitus in North India. J Diabetol. 2019; 10(1):25-8

Mithal A, Bansal B, Kalra S. Gestational diabetes in India: Science and society. Indian J Endocrinol Metab. 2015;19(6):701-4.

Majewska GB, Bomba-Opon D, Wielgos M. Association between intrahepatic cholestasis in pregnancy and gestational diabetes mellitus. A retrospective analysis. Ginekol Polska. 2019;90(8): 458-63.

Güvey H, Çelik S, Çalışkan CS, Yılmaz Z, Yılmaz M, Erten Ö, et al. How do serum zonulin levels change in gestational diabetes mellitus, pregnancy cholestasis, and the coexistence of both diseases?. Int J Environ Res Public Health. 2021;18(23):12555.

Ma K, Saha PK, Chan L, Moore DD. Farnesoid X receptor is essential for normal glucose homeostasis. J Clin Invest. 2006;116(4):1102-9.

Mencarelli RA, Vavassori P, Brancaleone V, Fiorucci S. The bile acid sensor FXR regulates insulin transcription and secretion. Biochem Biophys Acta. 2010;1802(3):363-72.

Hong S, Yu Z, Wang DH, Chen X, Jiang L, Shen H. Farnesoid X receptor induces GLUT4 expression through FXR response element in the GLUT4 promoter. Cellular physiology and biochemistry. Int J Exper Cellular Physiol Biochem Pharmacol. 2010; 22:1-14.

Arthur C, Mahomed K. Intrahepatic cholestasis of pregnancy: diagnosis and management; a survey of Royal Australian and New Zealand college of obstetrics and gynaecology fellows. Aust N Z J Obstet Gynaecol. 2014;54(3):263-7.

Diagnosis and management of gestational diabetes mellitus technical and operational guidelines by maternal health division, ministry of health and family welfare government of India. Available at: https://icogonline.org/wp-content/uploads/pdf/gcpr/ gdm-dipsi-guidline.pdf. Accessed on 20 November 2022.

Gencosmangolu TG, Vural YZ, Oguz Y, Yakut K, Sahal CY, Uygur D. Intrahepatic cholestasis of pregnancy is associated with gestational diabetes mellitus. Gynecol Obstet Reprod Med. 2019;25(3): 133-7.

Aftab N, Faraz S, Hazari K, Mahgoub FB. Maternal and fetal outcome in intrahepatic cholestasis of pregnancy in a multicultural society conducted at a tertiary care hospital in Dubai. Dubai Med J. 2021; 4:53-9.

Liu C, Gao J, Liu J, Wang X, He J, Sun J, Liu X, Liao S. Intrahepatic cholestasis of pregnancy is associated with an increased risk of gestational diabetes and preeclampsia. Ann Transl Med. 2020;8(23):1574.

Arafa A, Dong J, Arafa A. Association between intrahepatic cholestasis of pregnancy and risk of gestational diabetes and preeclampsia: A systematic review and meta-analysis. Hypertens Preg. 2020;39: 354-60.

Prabhu SS, Pullattayil AK, Lindow S. A meta-analysis of the prevalence of gestational diabetes in patients diagnosed with obstetrical cholestasis. AJOG Global Rep. 2021;1(3):2666.

Axelsen SM, Kampmann U, Koefoed AS, McIntyre D, Ovesen PG, Fuglsang J. Intrahepatic cholestasis of pregnancy: Association with glycaemic control in gestational diabetes. Diabet Med. 2021;38(8):e14574.

Mazhar SB, Gul-e-Irum. Fetomaternal outcome in pregnancy with cardiac disease. J Coll Physicians Surg Pak. 2005;15(8):476-80.

Kant A, Goswami S, Gupta U, Razdan A, Amle D. Maternal and perinatal outcome in cholestasis of pregnancy: a study in tertiary care hospital in North India. International J Reprod Contracept Obstet Gynecol. 2020;7:5066.

Binay M, Maji D, Borse D. A study on feto-maternal outcome of intra hepatic cholestasis of pregnancy. Int J Reprod Contracept Obstet Gynecol. 2019;9:318

Alsulyman OM, Ouzounian JG, Ames-Castro M, Goodwin TM. Intrahepatic cholestasis of pregnancy: perinatal outcome associated with expectant management. Am J Obstet Gynecol. 1996;175(4):957-60.

Singh S, Parihar S. Perinatal outcomes and intrahepatic cholestasis of pregnancy: A prospective study. Int J Reprod Contracept Obstet Gynecol. 2019;8:1177.

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Published

2023-04-28

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Original Research Articles