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Intrahepatic cholestasis of pregnancy and associated adverse pregnancy and fetal outcomes: a 12-year population-based cohort study
Department of Obstetrics and Gynaecology, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden.
Orebro University Hospital. Karolinska Univ Hosp & Inst, Dept Med SoClinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital and Institutet, Stockholm, Sweden; Department of Paediatrics, Örebro University Hospital, Örebro, Swedenna, Clin Epidemiol Unit, Stockholm, Sweden.;Orebro Univ Hosp, Dept Paediat, Orebro, Sweden..ORCID iD: 0000-0003-1024-5602
Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital and Institutet, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska University Hospital and Institutet, Stockholm, Sweden.
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
Abstract [en]

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.
Keyword [en]
Bile acids, gestational diabetes, intrahepatic cholestasis of pregnancy, intrauterine fetal death, obstetric cholestasis, pre-eclampsia, stillbirth, ursodeoxycholic acid
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:oru:diva-56791DOI: 10.1111/1471-0528.12174ISI: 000317353900009PubMedID: 23418899Scopus ID: 2-s2.0-84876127062OAI: oai:DiVA.org:oru-56791DiVA: diva2:1084145
Funder
Swedish Society of Medicine
Note

Funding Agencies:

Swedish Research Council-Medicine  K2005-72X-04793-30A  522-2A09-195 

Fulbright Commission  

Regional research councils-ALF 

Available from: 2017-03-23 Created: 2017-03-23 Last updated: 2017-04-13Bibliographically approved

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