Predictive factors associated with disease recurrence in patients with severe intrahepatic cholestasis of pregnancy: a retrospective study of 118 cases

Wang, Ting; Zhou, Wangxiao; Jiang, Ruowei; Lai, Jianbo; Jiang, Peiyue; Chen, Xinning; Li, Baohua

doi:10.1080/14767058.2021.1925645

Cited by 3 publications

(1 citation statement)

References 32 publications

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“…73 A large retrospective clinical study confirmed that the recurrence rate of ICP in subsequent pregnancies is high, especially for early-onset and severe ICP; recurrent ICP tends to occur earlier in gestation, is more severe, and has worse pregnancy outcomes. 74 Thus, this guideline recommends that women with a history of ICP should be vigilant for possible recurrence in subsequent pregnancies; early pregnancy screening for TBA and liver function should be conducted.…”

Section: Recommendation 9-3mentioning

confidence: 99%

Clinical Management Guidelines for Intrahepatic Cholestasis of Pregnancy

Yu,

Yang,

2024

Maternal Fetal Med

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Intrahepatic cholestasis of pregnancy (ICP) is a significant gestational complication in late pregnancy, potentially leading to severe perinatal complications such as intrauterine fetal demise and preterm birth. The Obstetrics Group of the Gynecology and Obstetrics Branch and the Perinatal Medicine Branch of the Chinese Medical Association organized a panel of domestic experts to deliberate and propose recommendations based on domestic and international guidelines, recent evidence-based medical evidence about key clinical issues including risk factors, clinical manifestations, perinatal outcomes, diagnosis, severity grading, maternal and fetal monitoring, treatment methods, timing and methods of pregnancy termination, and postpartum follow-up for ICP, with the aim to guide its clinical diagnosis, treatment, and management.

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Section: Recommendation 9-3mentioning

confidence: 99%

Clinical Management Guidelines for Intrahepatic Cholestasis of Pregnancy

Yu,

Yang,

2024

Maternal Fetal Med

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Thiopurine Metabolite Shunting in Late Pregnancy Increases the Risk of Intrahepatic Cholestasis of Pregnancy in Women With Inflammatory Bowel Disease, and Can be Managed With Split Dosing

Prentice,

Flanagan,

Wright

et al. 2024

Journal of Crohn's and Colitis

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Background and Aims The risk of intrahepatic cholestasis of pregnancy (ICP) is increased in thiopurine exposed pregnancies. Thiopurine ‘shunting’, with a 6-methylmecrcaptopurine (MMP) to 6-thioguanine (TGN) ratio of >11, progresses over pregnancy, and may promote ICP development. We aimed to explore the association between thiopurine exposure and ICP, including the hypothesized impact of thiopurine shunting, and identify risk minimization strategies. Methods This prospective multi-centre cohort study compared thiopurine and biologic monotherapy exposed pregnant participants. Disease activity and obstetric outcome data, thiopurine metabolites, bile acids and transaminases were obtained preconception, in each trimester, at delivery, and post-partum. Thiopurine dose management was at the discretion of the treating physician. Results 131 thiopurine and 147 biologic monotherapy exposed pregnancies were included. MMP/TGN ratio increased from preconception to third trimester (p<0.01), with approximately 25% of participants shunting in pregnancy. Second trimester split-dosing led to a decrease in the median MMP/TGN ratio from 18 (IQR 6-57) to 3 (IQR 2-3.5) at delivery (p=0.04). The risk of ICP was increased in thiopurine exposed pregnancies (6.7% (7/105) vs 0% (0/112), p<0.001), with all ICP cases occurring in the setting of antenatal thiopurine shunting. Thiopurine dose increases (RR 8.10 [95% CI 1.88-34.85] p=0.005) and shunting in third trimester (6.20 [1.21-30.73] p=0.028) and at delivery (14.18 [1.62-123.9] p=0.016) were associated with an increased risk of ICP. Conclusions Thiopurine exposure is associated with an increased risk of ICP, particularly following dose increases antenatally and with shunting in late pregnancy. The latter may be effectively managed with split dosing, although further studies are warranted.

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ICP – could there be a virus in the works?

Giles,

Hague,

Edwards

2024

Obstet Med

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Intrahepatic cholestasis of pregnancy (ICP) is the most common liver-specific disorder affecting pregnant women, with an Australian incidence of 0.6% pa and recurring in 70% of those affected. ICP causes mild to severe pruritus, often resulting in considerable skin excoriations, profound sleep disturbances, and severe anxiety, and yet the aetiology and optimal treatment or management of this condition remains unknown. In this review, we consider the role of viruses in causing or exacerbating ICP and discuss viruses that have been most closely implicated in the disease, including the role of Hepatitis B and Hepatitis C viruses in ICP.

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Predictive factors associated with disease recurrence in patients with severe intrahepatic cholestasis of pregnancy: a retrospective study of 118 cases

Cited by 3 publications

References 32 publications

Clinical Management Guidelines for Intrahepatic Cholestasis of Pregnancy

Clinical Management Guidelines for Intrahepatic Cholestasis of Pregnancy

Thiopurine Metabolite Shunting in Late Pregnancy Increases the Risk of Intrahepatic Cholestasis of Pregnancy in Women With Inflammatory Bowel Disease, and Can be Managed With Split Dosing

ICP – could there be a virus in the works?

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