INTRAHEPATIC CHOLESTASIS OF PREGNANCY AND NEONATAL RDS: FIRST EVIDENCE OF A CORRELATION: 83

BACKGROUND Intrahepatic Cholestasis of Pregnancy (ICP) impairs the placental clearance of bile acids (BA) and has been associated with perinatal morbidity but no adverse outcomes have been reported in the newborn. We have recently supposed a causative role of ICP in 3 cases of respiratory distress syndrome (RDS) in near term neonates in which the most common etiologies were excluded. For this reason we conducted a retrospective cohort study to verify the association between ICP and RDS and to clarify the role of BA in the RDS occurrence. METHODS We took data from our Division database about all newborns born during the years 2000 - 2004. Infants with Apgar's score < 7 at 5 minutes, any evidence of liver disease, major malformations or chromosomal aberrations were excluded from the study. Study neonates were 77 infants born from pregnancies complicated by the only ICP whereas control neonates were 427 infants born from pregnancy without any signs of ICP. In the ICP group we also studied maternal BA levels just before the delivery and neonatal BA levels during the first 24 hour of life. RESULTS Univariate analysis showed a double incidence of RDS among newborns from ICP pregnancies(28.6% vs. 14%; p < 0.001). In the multivariate analysis, after adjustment for gestational age, sex and rate of antenatal steroids, ICP still was a factor significantly associated to the occurrence of neonatal RDS. CONCLUSIONS This study demonstrates that ICP can play a significant role in the genesis of RDS in near term and mild preterm infants in which other causes are uncommon. BA can produce surfactant inactivation in the alveoli reverting the reaction of phospholipase A2. In the lungs. Prospective studies are needed to answer several open questions.