title: Intrahepatic cholestasis of pregnancy: maternal and fetal outcomes associated with elevated bile acid levels.
abstract: OBJECTIVE
  The primary aim of this study was to investigate the correlation between pregnancy outcome and bile acid (BA) levels in pregnancies that were affected by intrahepatic cholestasis of pregnancy (ICP). In addition, correlations between maternal and fetal BA levels were explored.
  
  
  METHODS
  We conducted a retrospective study that included women with pruritus and BA levels ≥10 μmol/L between January 2005 and August 2012 in 3 large hospitals in the Netherlands. The study group was divided in mild (10-39 μmol/L), moderate (40-99 μmol/L), and severe (≥100 μmol/L) ICP. Main outcome measures were spontaneous preterm birth, meconium-stained amniotic fluid, asphyxia, and perinatal death. Univariate and multivariate logistic regression analysis was used to study associations between BA levels and adverse outcome.
  
  
  RESULTS
  A total of 215 women were included. Gestational age at diagnosis and gestational age at delivery were significantly lower in the severe, as compared with the mild, ICP group (P < .001). Spontaneous preterm birth (19.0%), meconium-stained fluid (47.6%), and perinatal death (9.5%) occurred significantly more often in cases with severe ICP. Higher BA levels were associated significantly with spontaneous preterm birth (adjusted odds ratio [aOR], 1.15; 95% confidence interval [CI], 1.03-1.28), meconium-stained amniotic fluid (aOR, 1.15; 95% CI, 1.06-1.25), and perinatal death (aOR, 1.26; 95% CI, 1.01-1.57). Maternal BA levels at diagnosis and at delivery were correlated positively with umbilical cord blood BA levels (P = .006 and .012, respectively).
  
  
  CONCLUSIONS
  Severe ICP is associated with adverse pregnancy outcome. Levels of BA correlate between mother and fetus.
authors.affiliation: Department of Obstetrics, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Laura
authors.initials: L
authors.lastname: Brouwers
authors.affiliation: Department of Obstetrics, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Maria P H
authors.initials: MP
authors.lastname: Koster
authors.affiliation: Department of Obstetrics, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Godelieve C M L
authors.initials: GC
authors.lastname: Page-Christiaens
authors.affiliation: Department of Clinical Chemistry and Hematology Laboratory, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Kemperman
authors.affiliation: Department of Obstetrics and Gynecology, Diakonessenhuis, Utrecht, the Netherlands.
authors.forename: Janine
authors.initials: J
authors.lastname: Boon
authors.affiliation: Department of Obstetrics and Gynecology, Meander Medical Center, Amersfoort, the Netherlands.
authors.forename: Inge M
authors.initials: IM
authors.lastname: Evers
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Auke
authors.initials: A
authors.lastname: Bogte
authors.affiliation: Department of Obstetrics, University Medical Center Utrecht, Utrecht, the Netherlands. Electronic address: m.a.oudijk-3@umcutrecht.nl.
authors.forename: Martijn A
authors.initials: MA
authors.lastname: Oudijk
mesh_terms: D000328:Adult; D001647:Bile Acids and Salts / Q000097:blood*; D002780:Cholestasis, Intrahepatic / Q000097:blood* / Q000150:complications*; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D005333:Fetus; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood*; D011256:Pregnancy Outcome; D012189:Retrospective Studies
chemical_list: D001647:Bile Acids and Salts
keywords: adverse pregnancy outcome; bile acid; intrahepatic cholestasis; perinatal death