Abstract
BackgroundIntrahepatic cholestasis of pregnancy (ICP) has important fetal implications. There is increased risk for poor fetal outcomes, including preterm delivery, meconium staining of amniotic fluid, respiratory distress, fetal distress and demise.MethodsOne hundred and one women diagnosed with ICP between January 2005 and March 2009 at San Francisco General Hospital were included in this study. Single predictor logistic regression models were used to assess the associations of maternal clinical and biochemical predictors with fetal complications. Clinical predictors analyzed included age, race/ethnicity, gravidity, parity, history of liver or biliary disease, history of ICP in previous pregnancies, and induction. Biochemical predictors analyzed included serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total bilirubin, direct bilirubin, albumin, total protein, and total bile acids (TBA).ResultsThe prevalence of ICP was 1.9%. Most were Latina (90%). Labor was induced in the majority (87%) and most were delivered by normal spontaneous vaginal delivery (84%). Fetal complications occurred in 33% of the deliveries, with respiratory distress accounting for the majority of complications. There were no statistically significant clinical or biochemical predictors associated with an increased risk of fetal complications. Elevated TBA had little association with fetal complications until reaching greater than 100 µmoL/L, with 3 out of 5 having reported complications. ICP in previous pregnancies was associated with decreased risk of fetal complications (OR 0.21, p = 0.046). There were no cases of late term fetal demise.ConclusionsMaternal clinical and laboratory features, including elevated TBA, did not appear to be substantial predictors of fetal complications in ICP.
Highlights
Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disease seen in pregnancy
There is minimal data on the incidence of ICP in the United States, with recent reports stating an incidence of 0.3%, and a recent study on a Latina population in Southern California that determined the overall prevalence in their population to be 5.6%, 10 to 100 times higher than previously reported for the U.S population [2,3,4]
The aim of our study is to describe maternal and fetal characteristics associated with ICP in a cohort of patients in Northern California and to determine if significant clinical and biochemical predictors of fetal complications in women diagnosed with ICP exist
Summary
Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disease seen in pregnancy. ICP has been found to be associated with increased risk of preterm delivery, meconium staining of amniotic fluid, fetal bradycardia, fetal distress and fetal demise [2,5,6]. Poor fetal outcomes, including asphyxial events and spontaneous preterm delivery, have been shown to be associated with elevated maternal total serum bile acids (.40 micromol/L) in pregnancy [7]; specific predictors of pregnancy outcomes have not been consistently identified [6,7]. Intrahepatic cholestasis of pregnancy (ICP) has important fetal implications. There is increased risk for poor fetal outcomes, including preterm delivery, meconium staining of amniotic fluid, respiratory distress, fetal distress and demise
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