title: Intrahepatic cholestasis of pregnancy and associated adverse pregnancy and fetal outcomes: a 12-year population-based cohort study.
abstract: OBJECTIVE
  To determine the risk for adverse pregnancy and fetal outcomes in intrahepatic cholestasis of pregnancy (ICP).
  
  
  METHODS
  Population-based cohort study.
  
  
  METHODS
  Swedish Medical Birth Register (MBR) 1997-2009.
  
  
  METHODS
  A total of 1,213,668 singleton deliveries.
  
  
  METHODS
  Linkage of Hospital Discharge Register for exposure (ICP; n=5,477) with MBR for covariates.
  
  
  METHODS
  Gestational diabetes, pre-eclampsia, prematurity, and stillbirth.
  
  
  RESULTS
  Intrahepatic cholestasis (ICP) was diagnosed in 0.32-0.58% of all pregnancies, with an increasing trend until 2005 (P<0.0001). Compared with women who did not have ICP, women with ICP were more likely to have gestational diabetes (adjusted odds ratio, aOR, 2.81; 95% CI 2.32-3.41) and pre-eclampsia (aOR 2.62, 95% CI 2.32-2.78). Women with ICP were also more likely to have spontaneous (aOR 1.60, 95% CI 1.47-1.93) and iatrogenic (aOR 5.95, 95% CI 5.23-6.60) preterm delivery, with increased rates of induction of labour (aOR 11.76, 95% CI 11.04-11.62). However, this actively managed cohort of ICP cases was not at increased risk of stillbirth (aOR 0.92, 95% CI 0.52-1.62). Infants in ICP deliveries were more likely to have a low (<7) 5-minute Apgar score (aOR 1.45, 95% CI 1.14-1.85) and be large for gestational age at birth (aOR 2.27, 95% CI 2.02-2.55).
  
  
  CONCLUSIONS
  Over time, a greater proportion of Swedish pregnant women have received a diagnosis of ICP, probably because of an increased awareness of the disorder. Our data confirm an increased risk of preterm delivery, but not of stillbirth, in actively managed ICP. The high rates of gestational diabetes and pre-eclampsia are new findings, and need to be considered in the management of ICP pregnancies.
authors: Department of Obstetrics and Gynaecology, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
authors: E
authors: E
authors: Wikström Shemer
authors: H U
authors: HU
authors: Marschall
authors: J F
authors: JF
authors: Ludvigsson
authors: O
authors: O
authors: Stephansson
mesh_terms: D002780:Cholestasis, Intrahepatic / Q000453:epidemiology*; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D011225:Pre-Eclampsia / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D012307:Risk Factors; D050497:Stillbirth; D013548:Sweden / Q000453:epidemiology