Perinatal outcomes associated with intrahepatic cholestasis of pregnancy

Abstract

Severe cholestasis is associated with neonatal morbidity which antenatal testing may not predict.

Predictors of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy

“…One of the major complications of cholestasis of pregnancy is prematurity [2,16,17]. In the literature, the incidence of prematurity in ICP patients is 19-60% [6].…”

“…The incidence of the disease is reported to be 0.1% to 15.6% worldwide [1]. The maternal effects of ICP have a benign course, although ICP can lead to important consequences in the foetus and can cause many foetal complications, including intrauterine foetal loss [2]. Human and animal studies have shown that the transplacental transfer of bile acids is impaired in ICP patients [3,4].…”

“…To avoid foetal complications caused by ICP, delivery either after foetal lung maturation or 37 weeks is a frequently used approach [4,5]. It is thought that markedly elevated bile acids and advanced gestation are more important in the development of foetal complications [2]. As a result, there are data showing that the same approach should not be used in every ICP patient; in particular, a more expedient approach should be taken for patients with serum bile acids below 40 μmol/L, although this issue is still unclear.…”

Association of Adverse Perinatal Outcomes of Intrahepatic Cholestasis of Pregnancy With Biochemical Markers: Results of Aggregate and Individual Patient Data Meta-analyses

“…Other small studies have previously suggested an association between intrahepatic cholestasis of pregnancy and adverse perinatal risks, but their clinical implications have been limited by their size. 11,27,31,45 Cui and colleagues 46 did a meta-analysis with extracted data from women with intrahepatic cholestasis of pregnancy and showed that adverse perinatal outcomes (eg, preterm birth) were increased in women with bile acids greater than 40 µmol/L compared with women with lower bile acids, but did not report effects on stillbirth risks. Thus, the clear bile acid threshold of 100 µmol/L beneath which the prevalence of stillbirth was not increased is a novel and important finding in our study.…”

“…9 The 2007 stillbirth workshop 10 included intrahepatic chole stasis of pregnancy as a medical disorder that can cause stillbirth in pregnancies when the maternal serum bile acid concentration is increased. 4,6,7,11 To our knowledge, no studies have been adequately powered to assess whether intrahepatic cholestasis of pregnancy -associated fetal death occurs above a certain bile acid threshold, and clinical guidelines are largely reliant upon expert consensus to determine the optimal management of affected women. 12,13 Clinicians often recommend management ranging from surveillance to iatrogenic delivery to prevent the subsequent risk of fetal death, at gestations typically between 36 weeks and 40 completed weeks, although the evidence behind this approach is scarce.…”