title: Fetal outcomes in pregnancies complicated by intrahepatic cholestasis of pregnancy in a Northern California cohort.
abstract: BACKGROUND
  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.
  
  
  METHODS
  One 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).
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  Maternal clinical and laboratory features, including elevated TBA, did not appear to be substantial predictors of fetal complications in ICP.
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Michelle
authors.initials: M
authors.lastname: Rook
authors.forename: Juan
authors.initials: J
authors.lastname: Vargas
authors.forename: Aaron
authors.initials: A
authors.lastname: Caughey
authors.forename: Peter
authors.initials: P
authors.lastname: Bacchetti
authors.forename: Philip
authors.initials: P
authors.lastname: Rosenthal
authors.forename: Laura
authors.initials: L
authors.lastname: Bull
mesh_terms: D000328:Adult; D002140:California; D002780:Cholestasis, Intrahepatic / Q000378:metabolism / Q000503:physiopathology*; D015331:Cohort Studies; D005260:Female; D005333:Fetus; D006801:Humans; D016015:Logistic Models; D011247:Pregnancy; D011248:Pregnancy Complications / Q000378:metabolism / Q000503:physiopathology*; D011256:Pregnancy Outcome; D012189:Retrospective Studies