The prevalence of intrahepatic cholestasis of pregnancy in a primarily Latina Los Angeles population

Abstract

Objective: To establish the prevalence of intrahepatic cholestasis of pregnancy (ICP) in a primarily Latina population in the United States.Study design: Over a period of 16 months, a convenience sample of subjects admitted to labor and delivery in the third trimester was enrolled. Each subject completed a questionnaire rating their severity of pruritus on a numeric scale of 1 to 10. Serum was analyzed via radioimmunoassay for total bile acid concentration. ICP was defined as pruritus score >4 and a total serum bile acid concentration of X20 mmol/l. Ethnicity was determined from hospital record demographic data.Results: All invited participants enrolled in the study. Three hundred and forty subjects were enrolled. Three hundred and sixteen subjects (93%) were identified as Latina. The serum bile acid concentration range for the entire study population was 1 to 580 mmol/l with a mean of 10.4±34.9 mmol/l. Twenty-four (7.1%) subjects had a serum bile acid concentration X20 mmol/l. A pruritus score >4 was found in 19.7% (67/ 340). Of the 24 subjects with a bile acid concentration X20 mmol/l, 19 also had a pruritus score >4. Thus, the prevalence of ICP in this population was 5.6% (19/340). In subjects with ICP, the mean serum bile acid concentration was 89.5±124.0 mmol/l. When controlling for confounders, women with ICP were associated with higher rates of chorioamnionitis (P ¼ 0.043) and their fetuses had higher rates of thick meconium (P ¼ 0.053). Conclusions:The overall prevalence of ICP in this population was 5.6%, 10 to 100 times higher than previously reported data from the United States. Larger studies of perinatal morbidity examining the diagnostic criteria of cholestasis need to be conducted.

ACG Clinical Guideline: Liver Disease and Pregnancy

“…IHCP is the most common liver disease in pregnancy with prevalence ranging between 0.3 and 5.6% (36)(37)(38). IHCP presents in the second and third trimesters as persistent pruritus, typically involving the palms and soles as well as the rest of the body, with elevated bile acid levels, and resolves with delivery.…”

The risk of infant and fetal death by each additional week of expectant management in intrahepatic cholestasis of pregnancy by gestational age

“…1-5 A prevalence of 5.6% of ICP has been reported in a Los Angeles population that was primarily Latina. 6 Adverse fetal outcomes associated with ICP reported in literature include spontaneous and iatrogenic preterm birth, fetal distress, respiratory distress syndrome, meconium staining, neonatal intensive care unit admission, and stillbirth. 4,7-10 Fetal mortality is reported up to 1.5-7% but as high as 20% in some studies.…”

Pregnancy and liver disease

“…However, the low prevalence rate in the United States can be misleading. A recent study examining the prevalence of IHCP in a primarily Latino Los Angeles population found that the overall prevalence of IHCP in this population was much higher (5.6%) [2]. The authors attributed the high prevalence to the ethnic background of the patients they served, 93% (316 of 340) of whom identified themselves as Latino in origin.…”

“…Nevertheless, there are clear ethnic and racial differences. The disease has been described worldwide; however, the highest incidence is found in Chile and Bolivia, where the prevalence has been reported from 4% to 22% [2]. In Scandinavian countries (where it was first described), the incidence is moderate, between 1% and 2%.…”