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Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: A prospective population-based case-control study

Research output: Contribution to journalArticle

Victoria Geenes, Lucy C. Chappell, Paul T. Seed, Philip J. Steer, Marian Knight, Catherine Williamson

Original languageEnglish
Pages (from-to)1482-1491
Number of pages10
JournalHepatology
Volume59
Issue number4
Early online date15 Jul 2013
DOIs
Publication statusPublished - Apr 2014

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Abstract

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disease, characterised by maternal pruritus and raised serum bile acids. Our objectives were to describe the epidemiology and pregnancy complications associated with severe ICP and to test the hypothesis that adverse perinatal outcomes are increased in these women. A prospective population-based case-control study with national coverage was undertaken using the UK Obstetric Surveillance System (UKOSS). Control data for comparison were obtained from women with healthy pregnancy outcome through UKOSS (n=2232), St Mary's Maternity Information System (n=554,319) and Office for National Statistics (n=668,195). The main outcome measures investigated were preterm delivery, stillbirth and neonatal unit admission. 713 confirmed cases of severe ICP were identified, giving an estimated incidence of 9.2 per 10,000 maternities. Women with severe ICP and a singleton pregnancy (n=669) had increased risks of preterm delivery (164/664; 25% vs. 144/2200; 6.5%; adjusted OR 5.39, 95% CI 4.17 to 6.98), neonatal unit admission (80/654; 12% vs. 123/2192; 5.6%; adjusted OR 2.68, 95% CI 1.97 to 3.65) and stillbirth (10/664; 1.5% vs. 11/2205; 0.5%; adjusted OR 2.58, 95% CI 1.03 to 6.49) compared to controls. Seven of 10 stillbirths in ICP cases were associated with co-existing pregnancy complications. These differences remained significant against national data. Risks of preterm delivery, meconium-stained amniotic fluid and stillbirth rose with increasing maternal serum bile acid concentrations. Conclusions: In the largest prospective cohort study in severe ICP to date, we demonstrate significant increased risks of adverse perinatal outcomes, including stillbirth. Our findings support the case for close antenatal monitoring of pregnancies affected by severe ICP.

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