The correlation between blood lipids and intrahepatic cholestasis syndrome during pregnancy

Figures & data

Figure 1. Patient flow diagram in this study. All women deliver at full term with no foetal chromosomal or structural anomalies.

Table 1. Analysis of differences in lipid levels between patients with cholestasis of pregnancy and normal pregnant controls.

Characteristics	Healthy pregnant women (n = 269)	ICP (n = 204)	p Value
HDL (mmol/L)	1.83 (1.64, 2.02)	1.8 (1.52, 2.0375)	.122
LDL (mmol/L)	2.8 (2.375, 3.165)	3.18 (2.61, 3.8975)	<.001*
CHOL (mmol/L)	5.3 (4.795, 5.61)	5.585 (4.83, 6.5175)	<.001*
TG (mmol/L)	2.49 (1.82, 3.27)	2.79 (2.2425, 3.6575)	.001*
APOA (g/L)	1.83 (1.675, 1.985)	1.72 (1.5525, 1.91)	<.001*
APOB (g/L)	0.99 (0.85, 1.1)	1.14 (0.9425, 1.3875)	<.001*
APOA/APOB	1.8393 (1.5758, 2.2308)	1.5137 (1.2054, 1.8339)	<.001*
HDL/LDL	0.65 (0.5508, 0.7852)	0.5524 (0.4453, 0.6647)	<.001*

ICP: intrahepatic cholestasis of pregnancy; HDL: high-density lipoprotein; LDL: low-density lipoprotein; CHOL: cholesterol; TG: triglycerides; APOA: apolipoprotein A; APOB: apolipoprotein B.

Data show the number of participants in each group (n) and the median (quartile [P25–P75]).

* Significant at p < .05, based on the Mann–Whitney U-test.

Table 2. Correlation analysis between changes in serum ALT, AST and TBA ­levels and blood lipid levels in patients with ICP (n = 204).

Characteristics	ALT		AST		TBA
	R	p	R	p	R	p
HDL (mmol/L)	−0.358	<.001*	−0.349	<.001*	−0.491	<.001*
LDL (mmol/L)	0.15	.034	0.142	.044	−0.7	.32
CHOL (mmol/L)	−0.1	.883	−0.006	.929	−0.271	<.001*
TG (mmol/L)	0.012	.87	0.033	.645	−0.201	.004
APOA (g/L)	−0.423	<.001*	−0.41	<.001*	−0.581	<.001*
APOB (g/L)	0.116	.101	0.111	.116	−0.088	.214
APOA/APOB	−0.348	<.001*	−0.34	<.001*	−0.402	<.001*
HDL/LDL	−0.397	<.001*	−0.39	<.001*	−0.396	<.001*

R: correlation coefficient.

* p < .05.

Figure 2. ROC curves for the differential diagnosis of cholestasis of pregnancy for each blood lipid index. (A) Receiver operating characteristic (ROC) curves of triglyceride (TG), apolipoprotein B (APOB), low-density lipoprotein (LDL) and total cholesterol (TC) levels for the differential diagnosis of cholestasis of pregnancy. (B) ROC curves of apolipoprotein A (APOA) levels, the APOA/APOB ratio and the high density lipoprotein (HDL)/LDL ratio for the differential diagnosis of cholestasis of pregnancy.

Table 3. Evaluation of the diagnostic effect of each indicator on cholestasis of pregnancy.

Characteristics	AUC	Sensitivity	Specificity	p Value	Cut-off value
LDL (mmol/L)	0.672	0.929	0.412	<.001	3.495
CHOL (mmol/L)	0.626	0.978	0.466	<.001	5.855
APOB (g/L)	0.695	0.874	0.475	<.001	1.165
TG (mmol/L)	0.587	0.73	0.435	.001	2.305
APOA (g/L)	0.617	0.613	0.574	<.001	1.755
APOA/APOB	0.727	0.859	0.475	<.001	1.4781
HDL/LDL	0.693	0.844	0.456	<.001	0.52

Data show the number of participants in each group. TG, APOA and TBA levels are presented as the mean ± standard error of mean. HDL, LDL, CHOL and APOB levels are presented as medians (quartiles [P25–P75]).

Table 4. Regression analysis of intrahepatic cholestasis of pregnancy risk factors.

Characteristics	Cut-off value	Control (n = 269)	ICP (n = 204)	OR	95% CI	p Value	OR^#	95% CI^#	p Value^#
LDL (mmol/L)	<3.495	250	120
	≥3.495	19	84	9.211	5.349, 15.859	<.001	9.367	5.356, 16.381	<.001*
CHOL (mmol/L)	<5.855	263	109
	≥5.855	6	95	38.203	16.252, 89.804	<.001	41.955	17.522, 100.461	<.001*
TG (mmol/L)	<2.305	117	55
	≥2.305	152	149	1.956	1.309, 2.922	<.001	2.085	1.409, 3.086	<.001*
APOA (g/L)	<1.755	104	117
	≥1.755	165	87	0.469	0.324, 0.679	<.001	0.498	0.34, 0.728	<.001*
APOB (g/L)	<1.165	235	107
	≥1.165	34	97	6.266	3.985, 9.852	<.001	6.485	4.059, 10.359	<.001*
APOA/APOB	<1.165	36	94
	≥1.165	233	110	0.181	0.116, 0.282	<.001	0.171	0.108, 0.272	<.001*
HDL/LDL	<0.52	41	85
	≥0.52	228	119	0.252	0.163, 0.388	<.001	0.244	0.156, 0.382	<.001*

^# Adjusted statistics were calculated using logistic regression with adjustment for age.

* p < .05.

Table 5. Analysis of differences in serum lipid and bile acid levels between patients with uncomplicated ICP and ICP with pregnancy complications.

Disease	Character	n	HDL	LDL	CHOL	TG	APOA	APOB	TBA
ICP with GDM	Negative	127	1.84 (1.64, 2.04)*	3.29 (2.64, 3.94)	5.92 (5.01, 6.59)	3.1181 ± 1.34752	3.1181 ± 1.34752	1.2 (0.96, 1.41)	17.3323 ± 12.33887*
	Positive	36	1.675 (1.3175, 1.8875)*	3.035 (2.49, 3.625)	5.44 (4.695, 6.59)	3.3431 ± 1.32521	3.3431 ± 1.32521	1.14 (0.93, 1.39)	20.6139 ± 21.85064*
ICP with HDCP	Negative	156	1.81 (1.53, 2.0375)	3.28 (2.6125, 3.94)	5.87 (4.895, 6.6125)	3.1717 ± 1.36872	1.7217 ± 0.35181	1.18 (0.9425, 1.41)	18.2821 ± 15.2309
	Positive	7	1.78 (1.66, 2.04)	3 (2.95, 3.58)	5.41 (5.17, 6.13)	3.0814 ± 0.4562	1.7114 ± 0.36136	1.05 (1.01, 1.25)	13.0429 ± 3.03197
ICP with CH	Negative	142	1.805 (1.53, 2.03)	3.25 (2.6125, 3.9375)	5.63 (4.895, 6.5525)	3.1414 ± 1.32663	1.7336 ± 0.323*	1.175 (0.9525, 1.4)	17.1574 ± 11.91015*
	Positive	14	1.71 (1.53, 2.08)*	3.22 (2.77, 5.08)	6.16 (5.12, 7.82)	3.428 ± 1.50821	1.5987 ± 0.55959*	1.17 (1.03, 1.8)	26.9333 ± 31.67044*
ICP with PE	Negative	146	1.815 (1.5925, 2.04)*	3.25 (2.67, 3.9475)	5.93 (4.95, 6.6225)	3.128 ± 1.30024*	1.7387 ± 0.33268	1.19 (0.975, 1.41)	18.037 ± 15.48337
	Positive	17	1.64 (1.16, 1.83)	3.14 (2.385, 3.56)	5.27 (4.625, 6.165)	3.5094 ± 1.66436*	1.5712 ± 0.46724	1.09 (0.885, 1.22)	18.2294 ± 9.46677
ICP with HIS	Negative	147	1.8 (1.52, 2.03)	3.22 (2.61, 3.9)	5.6 (4.85, 6.5)	3.1586 ± 1.37662	1.7231 ± 0.35526	1.17 (0.94, 1.4)	18.0776 ± 15.45801
	Positive	16	1.82 (1.655, 2.07)	3.65 (2.8425, 5.095)	6.115 (5.3325, 7.485)	3.2519 ± 0.99568	1.7044 ± 0.32008	1.25 (1.0275, 1.65)	17.8688 ± 9.3405
ICP with premature rupture of foetal membranes	Negative	141	1.8 (1.56, 2.035)	3.27 (2.755, 3.935)	5.81 (5.005, 6.605)	3.1169 ± 1.34105	1.727 ± 0.34905	1.18 (0.985, 1.41)	17.7652 ± 12.43233
	Positive	22	1.825 (1.4025, 2.0425)	3.115 (2.2775, 3.9925)	5.565 (4.605, 6.7325)	3.4941 ± 1.33079	1.6841 ± 0.37008	1.105 (0.855, 1.37)	19.9273 ± 26.24816
Production mode of ICP	Eutocia	81	1.84 (1.665, 2.115)	3.11 (2.47, 3.785)	5.86 (4.975, 6.485)	3.2644 ± 1.50026	1.7793 ± 0.32406	1.12 (0.925, 1.395)	18.4333 ± 19.15927
	Caesarean	82	1.71 (1.5175, 1.99)	3.475 (2.7975, 3.9975)	5.63 (4.875, 6.6775)	3.0723 ± 1.16593	1.6639 ± 0.36893	1.21 (0.98, 1.4225)	17.6854 ± 9.16717
Timing of delivery OF ICP	Mature	137	1.83 (1.64, 2.075)*	3.16 (2.615, 3.895)*	5.81 (4.9, 6.53)	3.1461 ± 1.30149*	1.7846 ± 0.28261*	1.13 (0.945, 1.39)*	16.092 ± 6.62546*
	Premature delivery	26	1.53 (1.1425, 1.7975)*	3.555 (2.91, 4.9375)*	5.8 (4.9475, 7.4)	3.2819 ± 1.56086*	1.3873 ± 0.47569*	1.255 (1.065, 1.6975)*	28.4115 ± 32.80819*

Data show the number of participants in each group. TG, APOA and TBA levels are presented as the mean ± standard error of mean. HDL, LDL, CHOL and APOB levels are presented as medians (quartiles [P25–P75]).

* p < .05.

Data availability statement

All generated raw data and/or analysed data from the current study are available from the corresponding author on reasonable request.