Relationship Between Fetal Total Bile Acid And The Change Of Fetal Pancreatic Endocrine Function, And Its Influence To Fetal Growth And Development In Intrahepatic Cholestasis Of Pregnancy

ObjectiveTo investigate the relationship between fetal total bile acid and the change of fetal pancreatic endocrine function,and its influence to fetal growth and development in intrahepatic cholestasis of pregnancy (ICP).MethodsThe concentration of TBA,insulin,glucagons and glucose in the cord blood were measured in 30 fetuses of ICP (case group)and 30 fetuses of normogravidas(control group)after elective cesarean section. The cord blood TBA concentration was investigated by enzyme method and the cord concentration of insulin and glucagons were investigated by radioimmunoassay. The glucose was measured by oxidase-superoxide method. The neonatal weighs length and Ponderal index were measured within 15 minutes after parturition.Results1. The cord blood insulin concentration(8.96+3.29mIU/L) and insulin-to-glucagons ratio(0.048±0.028)in case group were significantly lower than that of the control(10.10±3.68mIU/L,0.050±0.020),The concentration of TBA(10.31±3.79umol/L)and glucagons(235.32±56.59pg/ml)in case group were obviously higher than those of the control(4.11±1.31umol/ L,204.50±33.95pg/ml),But no difference was shown in the concentration of glucose between case and control group[(3.44±1.14mmol/l) vs.(3.57±1.17mmol/L ),P>0.05].2. The neonatal weight and length in case group were significantly lower than those of control [3162.92±478.28vs3497.97±393.00g, 46.48±2.34 vs49.31±1.88cm, P<0.01], while the Ponderal index in case group was significantly higher than that of control (3.13±0.23vs2.92±0.29,P<0.01).3. The cord blood TBA concentration respectively showed straight line relationship with the cord blood insulin concentration,the cord blood glucagons concentration and insulin-to-glucagons ratio in case group. With the cord blood TBA concentration increasing, the cord insulin concentration and the ratio of insulin over glucagons decreased, meanwhile the cord blood glucagons concentration raised.(Linear regression equation were Y₁=12.593-0.223X₁;Y₂=204.438+2.997X₂;Y₃=0.066-0.002X₃,P<0.01).4 . The cord blood glucose, insulin, glucagons and insulin-to-glucagons ratio were the factors that affect neonatal PI, and the order respectively was insulin-to-glucagons ratio, insulin, glucose, glucagons(P<0.01).General regression equation was Y=3.136+0.01X₁-0.056X₂+0.001X₃+7.167X₄ , (P<0.01).Conclusion1.Fetal pancreatic endocrine secretion exists hypoinsulinism, glucagons oversecretion, insulin-to-glucagons ratio decline in ICP and TBA may be one of the reasons that cause above-mentioned change.2.ICP exists anomaly fetal growth and development, which is intimately correlated with cord blood glucose, insulin , glucagons and insulin-to-glucagons ratio, especially insulin-to-glucagons ratio.