Association between intrahepatic cholestasis in pregnancy and gestational diabetes mellitus. A retrospective analysis

Objectives: Intrahepatic cholestasis of pregnancy (ICP) is a liver specific disorder affecting 0.08%–27.6% pregnant women. It is characterized by reduced expression of the primary bile acid farnesoid receptor (FXR). In recent studies, it has been showed that FXR has an impact on normal glucose homeostasis. Based on that it was suggested that the level of bile acids correlates with glucose level. The aim of the study was to evaluate the association between ICP and gestational diabetes mellitus (GDM).  Material and methods: 102 singleton patients complicated by ICP were included to the study and divided into two groups: non-GDM group (74 patients) and GDM group (28 patients). ICP was diagnosed based on the serum bile acids level > 10 μmol/L and GDM with the 75 g oral glucose tolerance test and FIGO guidelines. Demographic and clinical outcome data (including maternal age, BMI and infant weight) and ICP and GDM biochemical markers were collected.  Results: The incidence of GDM in ICP patients was 27.45%. 73% of women included to the study developed mild cholestasis. Lower levels of serum bile acids were correlated with GDM group. When compared mean total bilirubin level was significantly higher in non-GDM group. Transaminases (ALT, AST) and neonate condition including mean birth weight revealed no significant difference between the groups. On the other hand, prevalence of large for gestational age was significantly higher in non-GDM group (p < 0.00001).  Conclusions: The incidence of ICP is higher in women with GDM.