Intrahepatic Cholestasis of Pregnancy and Neonatal Respiratory Distress Syndrome

Intrahepatic cholestasis of pregnancy (ICP) is a clinical syndrome of unknown pathophysiology, characterized by generalized pruritus and biochemical cholestasis, occurring during the second half of pregnancy and persisting until delivery.1 The incidence of ICP varies from 0.1% to 1.5% of pregnancies in Europe, North America, and Australia and from 9.2% to 15.6% in South American countries such as Bolivia and Chile.2 ICP may seriously impair the placental clearance of fetal bile acids (BAs), leading to a dangerous accumulation of these compounds within the fetus and the newborn.3 The elevation of maternal serum BA is thought to be the most appropriate biochemical parameter for diagnosing the ICP.4 This syndrome has been associated with increased fetal distress, premature delivery, perinatal mortality, and morbidity, but no adverse outcomes have been reported in the newborn, apart from 1 infant dead in the first hour after birth because of asphyxia.1 4 We have recently described 3 cases of respiratory distress syndrome (RDS) in near-term newborn infants in which the most common etiologies were excluded, and a causative role of BA was supposed, leading to the diagnosis of "BA pneumonia."5 In our article, we hypothesized that ICP and the abnormally high BA levels could have reversed the action of phospholipase A2 in the alveoli of our infants, causing a degradation of phosphatidylcholines to lysophosphatidylcholines, the relative lack of surfactant activity, and the consequent RDS.5 Therefore, we performed this retrospective study to establish the incidence of neonatal RDS after pregnancies complicated by ICP and to clarify whether neonatal RDS is associated with maternal ICP. The secondary aim of this study was to investigate whether neonatal RDS is related to the BA levels of the mother and/or the newborn.