Maternal soluble urokinase plasminogen activator receptor levels in intrahepatic cholestasis of pregnancy: a predictor of neonatal intensive care unit admission

Aktaş, Betül Akgün; Agaoglu, Zahid; Peker, Betül Nur; Başaran, Ezgi; Orhan, Nazlı; Özdal, Burcu Bozkurt; Şahin, Dilek

doi:10.1590/1806-9282.20251109

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Original Article • Rev. Assoc. Med. Bras. 71 (11) • 2025 • https://doi.org/10.1590/1806-9282.20251109 linkcopy

Maternal soluble urokinase plasminogen activator receptor levels in intrahepatic cholestasis of pregnancy: a predictor of neonatal intensive care unit admission

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE: The aim of this study was to compare maternal plasma soluble urokinase plasminogen activator receptor levels in pregnant women diagnosed with intrahepatic cholestasis of pregnancy with those in healthy pregnant women and to evaluate its predictive value for neonatal intensive care unit admission.

METHODS: This study is a prospective case-control study and was conducted with a total of 80 participants, including 38 pregnant women with intrahepatic cholestasis of pregnancy and 42 healthy pregnant women between 28 and 37 weeks of gestation. To evaluate the predictive value of maternal suPAR and bile acid levels for neonatal intensive care unit admission, receiver operating characteristic curves were generated.

RESULTS: Maternal serum alanine aminotransferase, aspartate aminotransferase, and direct bilirubin levels were statistically significantly higher in the intrahepatic cholestasis of pregnancy group compared to the control. In the intrahepatic cholestasis of pregnancy group, the plasma soluble urokinase plasminogen activator receptor level was 0.42±0.6 ng/mL, whereas in the control group it was 0.18±0.1 ng/mL (p=0.038). The intrahepatic cholestasis of pregnancy group delivered at an earlier gestational age and with lower birth weight, and the need for neonatal intensive care unit admission was statistically significantly higher. In both the severe and mild intrahepatic cholestasis of pregnancy groups, spontaneous preterm birth was more frequent than iatrogenic preterm birth. In the severe intrahepatic cholestasis of pregnancy group, there was one neonatal death and one meconium-stained birth. The discriminatory power of soluble urokinase plasminogen activator receptor levels in predicting neonatal intensive care unit need was found to be statistically significant (area under the curve: 0.757; 95%CI 0.552–0.962; p=0.022).

CONCLUSION: High maternal plasma soluble urokinase plasminogen activator receptor levels may predict adverse pregnancy outcomes.

KEYWORDS:
ICP; NICU; Receptors; Urokinase plasminogen activator; Pregnancy outcome

	Cholestasis group (n=38)	Control group (n=42)	p-value
Maternal age (years)	29.8±5.0	27.7±5.2	0.075
Nulliparity	16 (42.1)	15 (35.7)	0.558
Gestational week at diagnosis	32.9±2.6	34.1±2.9	0.079
SuPAR (ng/mL)*	0.42±0.6	0.18±0.1	0.038
ALT (U/L)*	190.2±216.8	16.7±7.8	<0.001
AST (U/L)*	130.1±169.4	16.5±9.2	<0.001
Total bilirubin (mg/dL)	0.66±0.3	0.49±0.1	0.089
Direct bilirubin (mg/dL)*	0.31±0.2	0.16±0.1	0.021
Gestational weeks at birth*	35.6±2.2	38.9±1.1	<0.001
Emergency cesarean	11 (28.9)	7 (16.6)	0.983
Birth weight (g)*	2,767.2±584.7	3,238.7±411.5	<0.001
APGAR fifth minute <7	2 (5.2)	0 (0)	<0.001
NICU*	9 (23.6)	3 (7.1)	0.024

	BA<40 (n=22)	BA≥40 (n=16)	p-value
Maternal age (years)	29.3±4.9	30.6±5.2	0.452
Nulliparity	9 (40.9)	7 (43.7)	0.861
Gestational weeks at diagnosis	33.4±2.0	32.3±3.2	0.185
Bile acid (mmol/L)*	20.5±8.0	75.3±22.4	<0.001
SuPAR (ng/mL)	0.33±0.3	0.54±1.1	0.337
ALT (U/L)*	105.6±85.5	306.5±284.2	0.003
AST (U/L)*	57.2±31	230.2±225.8	0.001
Total bilirubin (mg/dL)*	0.55±0.2	0.81±0.4	0.024
Direct bilirubin (mg/dL)*	0.22±0.1	0.43±0.2	0.003
Gestational weeks at birth	36.3±1.1	34.7±3.0	0.055
Emergency cesarean	5 (22.7)	6 (37.5)	0.291
Birth weight (gs)	2,844.1±303.0	2,660.7±838.8	0.389
APGAR fifth minute <7	1 (4.5)	1 (6.2)	0.811
NICU	3 (13.6)	6 (37.5)	0.074
Preterm delivery	10 (45.4)	12 (75)	0.069
Spontaneous	7 (31.8)	7 (43.7)
Iatrogenic	3 (13.6)	5 (31.2)
Neonatal pH*	7.47±0.2 (n=5)	7.29±0.1 (n=11)	0.021
Adverse obstetric outcome	10 (45.4)	12 (75)	0.069
Neonatal death	0 (0)	1 (6.2)
Meconium delivery	0 (0)	1 (6.2)

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Associação Médica Brasileira R. São Carlos do Pinhal, 324, 01333-903 São Paulo SP - Brazil, Tel: +55 11 3178-6800, Fax: +55 11 3178-6816 - São Paulo - SP - Brazil
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[TFN1] Note: Data are presented as mean ± standard deviation, number (n), and percentage (%).

[TFN2] ^*
Bold values denote statistical significance at the p<0.05 level. SuPAR: soluble urokinase plasminogen activator receptor; APGAR: appearance, pulse, grimace, activity, and respiration; ALT: alanine aminotransferase; AST: aspartate aminotransferase.