Comparison of seven bile acids in intrahepatic cholestasis by HPLC-MS/MS at different gestational stages and the clinical significance

Objective To compare the serum levels of seven bile acid subtypes at different gestational stages among pregnant women with intrahepatic cholestasis of pregnancy(ICP), pregnant women with abnormal liver function and normal pregnant women as well as the relationship between bile acid serum level with pregnancy outcomes so as to investigate value of bile acids analysis in clinical application. Methods A retrospective analysis of totally 84 ICP cases, 20 abnormal liver function cases and 30 normal cases underwent routine check-up and delivery in our hospital was collected from September 2018 to February 2019. At 9-13⁺⁶ weeks, 15-20⁺⁶ weeks and 28-40 weeks respectively, the venous serum samples of each case were collected and determined by high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) to come to measure the serum level of cholic acid (CA), chenodeoxycholic (CDCA) acid, glycocholic acid (GCA), taurocholic acid (TCA), glycochenodeoxycholic acid (GCDCA), lithocholic acid (LCA), and ursodeoxycholic acid (UDCA). The relationship with the corresponding pregnancy outcomes was analyzed. Results The levels of bile acid subtypes in ICP pregnant women in early, middle and late gestational stages were significantly higher than those in normal pregnant women and pregnant women with abnormal liver function, mainly GCA and TCA. The bile acids serum levels in ICP group significantly increased with the gestational week increasing. The seven bile acid subtypes varied differently in the three gestational stages. GCA level was negatively related to the gestational age of childbirth. The levels of GCA, LCA and GCDCA were negatively related to the weight of the newborn, and other bile acids were not significantly related to clinical outcomes. Conclusion The bile acid profiles of three groups vary with gestational weeks. The CA/CDCA ratio is expected to be an indicator to distinguish ICP pregnancy women from abnormal liver function ones. The increase of LCA, GCA, and GCDCA may be related to poor prognosis. Detecting seven bile acids by HPLC-MS/MS can be used for clinical diagnosis and therapeutic effect evaluation of ICP.