Research Report
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World J Obstet Gynecol. May 10, 2014; 3(2): 78-84
Published online May 10, 2014. doi: 10.5317/wjog.v3.i2.78
Fetal lung surfactant and development alterations in intrahepatic cholestasis of pregnancy
Yi-Ling Ding, Li-Juan Zhang, Xin Wang, Qi-Chang Zhou, Na Li, Chang-Xiu Wang, Xiu-Quan Zhang
Yi-Ling Ding, Li-Juan Zhang, Xin Wang, Na Li, Chang-Xiu Wang, Department of Obstetrics and Gynecology, Xiangya Second Hospital, Central South University, Changsha 410011, Hunan Province, China
Qi-Chang Zhou, Ultrasonography, Department of Radiology, Xiangya Second Hospital, Central South University, Changsha 410011, Hunan Province, China
Xiu-Quan Zhang, Department of Obstetrics and Gynecology and Reproductive Genetics, University of Utah School of Medicine, Salt Lake City, UT 84132, United States
Author contributions: Ding YL and Zhang LJ contributed equally to this work; Zhang LJ and Ding YL developed the conception and designed the study; Wang X, Li N and Wang CX collected and analyzed the data; Zhou QC conducted the ultrasonography; Zhang LJ and Zhang XQ drafted the manuscript and interpreted the data; Zhang XQ revised and final approved the manuscript.
Correspondence to: Xiu-Quan Zhang, MD, Department of Obstetrics and Gynecology and Reproductive Genetics, University of Utah School of Medicine, 50 North Medical. Drive, Salt Lake City, UT 84132, United States. xiuquan.zhang@hsc.utah.edu
Telephone: +1-801-5853117 Fax: +1-801-5813552
Received: June 28, 2013
Revised: November 21, 2013
Accepted: January 13, 2014
Published online: May 10, 2014
Abstract

AIM: To investigate the association between total bile acid (TBA) level during intrahepatic cholestasis of pregnancy (ICP) and fetal lung surfactant alteration.

METHODS: We recruited 42 ICP and 32 normal pregnancy women in this study. The maternal blood, fetal blood and amniotic fluid TBA level were detected using a circulating enzymatic method. Umbilical blood pulmonary surfactant protein A (SP-A) was evaluated with enzyme-linked immunosorbent assay. High performance liquid chromatography was used for the determination of phosphatidyl choline (PC), phosphatidyl inositol (PI), lysolecithin (LPC) and sphingomyelin (SM). Amniotic fluid lamellar body was counted with a fully automatic blood cell counter. Fetal lung area and fetal body weight were calculated from data obtained with an iu22 color supersonic diagnostic set. Clinical information of a nonstress test, amniotic fluid properties and neonatal Apgar score, and birth weight were recorded for review.

RESULTS: The TBA level in maternal blood, fetal blood and amniotic fluid in the ICP group were significantly higher than that in the control group (maternal blood: 34.11 ± 6.75 mmol/L vs 4.55 ± 1.72 mmol/L, P < 0.05; fetal blood: 11.9 ± 2.23 mmol/L vs 3.52 ± 1.56 mmol/L, P < 0.05; amniotic fluid: 3.89 ± 1.99 mmol/L vs 1.43 ± 1.14 mmol/L, P < 0.05). Amniotic fluid PC and PI in the ICP group were significantly lower than that in the control group (PC: 65.71 ± 7.23 μg/mL vs 69.70 ± 6.68 μg/mL, P < 0.05; PI: 3.87 ± 0.65 μg/mL vs 4.28 ± 0.74 μg/mL, P < 0.05). PC/LPC ratio of the ICP group was lower than that of the control group (14.40 ± 3.14 vs 16.90 ± 2.52, P < 0.05). Amniotic LB in the ICP group was significantly lower than that of the control group ((74.13 ± 4.37) × 109/L vs (103.0 ± 26.82) × 109/L, P < 0.05). Fetal umbilical blood SP-A level in the ICP group was significantly higher than that of the control group (30.26 ± 7.01 ng/mL vs 22.63 ± 7.42 ng/mL, P < 0.05). Fetal lung area/body weight ratio of the ICP group was significantly lower than that of the control group (5.76 ± 0.63 cm2/kg vs 6.89 ± 0.48 cm2/kg, P < 0.05). In the ICP group, umbilical cord blood TBA concentration was positively correlated to the maternal blood TBA concentration (r = 0.746, P < 0.05) and umbilical blood SP-A (r = 0.422, P < 0.05), but it was negatively correlated to the amniotic fluid lamellar corpuscle (r = 0.810, P < 0.05) and fetal lung area/body weight ratio (r = 0.769, P < 0.05). Furthermore, umbilical blood TBA showed a negative correlation to PC, SM and PI (rpc = 0.536, rsm = 0.438, rpi = 0.387 respectively, P < 0.05). The neonatal asphyxia, neonatal respiratory distress syndrome, fetal distress and perinatal death rates in the ICP group are higher than that of the control group.

CONCLUSION: ICP has higher TBA in maternal and fetal blood and amniotic fluid. The high concentration of TBA may affect fetal pulmonary surfactant production and fetal lung maturation.

Keywords: Intrahepatic cholestasis of pregnancy, Total bile acid, Pulmonary surfactant, Surfactant protein, Phospholipids, Amniotic fluid lamellar body

Core tip: We studied total bile acid (TBA) concentration in maternal, fetal and amniotic fluid and its relationship with fetal surfactant, surfactant protein A, amniotic lamellar body and fetal lung development. Results demonstrated that intrahepatic cholestasis of pregnancy (ICP) has higher TBA in maternal and fetal blood and amniotic fluid. The high concentration of TBA may affect fetal pulmonary surfactant production and fetal lung maturation. It calls attention to delayed maturation of fetal lungs in ICP patients and to take steps to carefully check and improve fetal pulmonary maturity.