Intrahepatic cholestasis of pregnancy: Relationships between bile acid levels and fetal complication rates.
Intrahepatic cholestasis of pregnancy (ICP), characterized by pruritus in the second half of pregnancy, entails an increased risk to the fetus. This study was designed to determine the incidence and fetal complication rates in ICP, and to define groups at increased risk. In an prospective cohort study conducted between February 1, 1999, and January 31, 2002, all 45,485 pregnancies in a defined region of Sweden (Västra Götaland) were screened for ICP, defined as otherwise unexplained pruritus of pregnancy in combination with fasting serum bile acid levels > or = 10 micromol/L. Pruritus was reported by 937 (2.1%) women, and ICP was diagnosed in 693 (1.5%). Simple logistic regression analyses showed that the probability of fetal complications (spontaneous preterm deliveries, asphyxial events, and meconium staining of amniotic fluid, placenta, and membranes) increased by 1%-2% per additional micromol/L of serum bile acids. Complementary analyses showed that fetal complications did not arise until bile acid levels were > or = 40 micromol/L. Gallstone disease and a family history of ICP were significantly (P < .001) more prevalent in the group of ICP patients with higher bile acid levels. In conclusion, we found an incidence of ICP in our population of 1.5%. From complication rates recorded prospectively, we could define a mild (81%) and a severe (19%) form of ICP, the latter with bile acid levels > or = 40 micromol/L. No increase in fetal risk was detected in ICP patients with bile acid levels < 40 micromol/L, and we propose that these women be managed expectantly, which would significantly reduce the costs of medical care.
Glantz
Anna
A
Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital/East, Göteborg, Sweden. anna.glantz@vgregion.se
Marschall
Hanns-Ulrich
HU
Mattsson
Lars-Ake
LA
D001647:Bile Acids and Salts / Q000097:blood*; D015148:Cardiotocography; D002780:Cholestasis, Intrahepatic / Q000097:blood* / Q000150:complications* / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005313:Fetal Death / Q000209:etiology; D005315:Fetal Diseases / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008499:Medical Records; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood*; D011272:Pregnancy, Multiple; D011446:Prospective Studies; D011537:Pruritus / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology; D014427:Twins
D001647:Bile Acids and Salts