Intrahepatic cholestasis of pregnancy: Relationships between bile acid levels and fetal complication rates

Abstract

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 ≥10 μmol/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 μmol/L of serum bile acids. Complementary analyses showed that fetal complications did not arise until bile acid levels were ≥40 μmol/L. Gallstone disease and a family history of ICP were significandy (P < 40 μmol/L limol/L, and we propose that these women be managed expectantly, which would significantly reduce the costs of medical care.