Intrahepatic cholestasis of pregnancy and associated adverse pregnancy and fetal outcomes: a 12-year population-based cohort study
2013 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 120, no 6, 717-723 p.Article in journal (Refereed) Published
Objective: To determine the risk for adverse pregnancy and fetal outcomes in intrahepatic cholestasis of pregnancy (ICP).
Design: Population-based cohort study.
Setting: Swedish Medical Birth Register (MBR) 19972009.
Population: A total of 1213668 singleton deliveries.
Methods: Linkage of Hospital Discharge Register for exposure (ICP; n=5477) with MBR for covariates.
Main outcome measures: Gestational diabetes, pre-eclampsia, prematurity, and stillbirth.
Results: Intrahepatic cholestasis (ICP) was diagnosed in 0.320.58% 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 2.323.41) and pre-eclampsia (aOR 2.62, 95% CI 2.322.78). Women with ICP were also more likely to have spontaneous (aOR 1.60, 95% CI 1.471.93) and iatrogenic (aOR 5.95, 95% CI 5.236.60) preterm delivery, with increased rates of induction of labour (aOR 11.76, 95% CI 11.0411.62). However, this actively managed cohort of ICP cases was not at increased risk of stillbirth (aOR 0.92, 95% CI 0.521.62). Infants in ICP deliveries were more likely to have a low (<7) 5-minute Apgar score (aOR 1.45, 95% CI 1.141.85) and be large for gestational age at birth (aOR 2.27, 95% CI 2.022.55).
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.
Place, publisher, year, edition, pages
Wiley-Blackwell, 2013. Vol. 120, no 6, 717-723 p.
Bile acids, gestational diabetes, intrahepatic cholestasis of pregnancy, intrauterine fetal death, obstetric cholestasis, pre-eclampsia, stillbirth, ursodeoxycholic acid
Obstetrics, Gynecology and Reproductive Medicine
IdentifiersURN: urn:nbn:se:oru:diva-56791DOI: 10.1111/1471-0528.12174ISI: 000317353900009PubMedID: 23418899ScopusID: 2-s2.0-84876127062OAI: oai:DiVA.org:oru-56791DiVA: diva2:1084145
FunderSwedish Society of Medicine
Swedish Research Council-Medicine K2005-72X-04793-30A 522-2A09-195
Regional research councils-ALF 2017-03-232017-03-232017-04-13Bibliographically approved