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Severe intrahepatic cholestasis of pregnancy linked to poor outcomes

Women with severe intrahepatic cholestasis of pregnancy are more likely to experience stillbirth and preterm delivery, according to recent results.

In a prospective, population-based case-control study, researchers evaluated data from 713 women with severe intrahepatic cholestasis of pregnancy (ICP) (serum bile acid of 40 mcmol/L or greater) identified through the UK Obstetric Surveillance System (UKOSS). Pregnancy outcomes of ICP patients were compared against those of healthy controls collected via UKOSS (n=2,232) and the Office for National Statistics (n=668,195).

Among women with singleton pregnancies (n=669, cases; n=2,205, controls), preterm delivery was more common in the severe ICP group compared with UKOSS controls (25% of cases vs. 6.5%; adjusted OR=5.39; 95% CI, 4.17-6.98). Stillbirth (1.5% vs. 0.5%; aOR=2.58; 95% CI, 1.03-6.49) and admission to a neonatal unit also were more common in these patients (12% vs. 5.6%; aOR=2.68; 95% CI, 1.97-3.65). Patients who experienced stillbirth had higher peak bile acid levels than those who gave live birth (median 137 mcmol/L vs. 72 mcmol/L; P=.0021).Associations between severe ICP and stillbirth (vs. 0.44%; OR=3.05; 95% CI, 1.65-5.63) and preterm delivery (vs. 8.9%; OR=3.39; 95% CI, 2.84-4.04) remained significant compared with national controls.

As maternal concentrations of serum bile acid increased, risks for stillbirth, preterm delivery and meconium staining of amniotic fluid rose — doubling of acid concentration increased still birth risk by 200%, preterm delivery risk by 68% and meconium staining risk by 55%. ALT levels also were weakly associated with preterm delivery risk.

Catherine Williamson

“This is the largest prospective cohort study in ICP, and has shown for the first time that bile acid levels above 40 mcmol/L in the mother are associated with increased risk of stillbirth, in addition to confirming the association between high maternal bile acid and spontaneous preterm labor, increased rates of meconium-stained amniotic fluid and prolonged admission to the neonatal unit,” Catherine Williamson, MD, professor of women’s health at King’s College in London, told Healio.com. “We hope that this new study will be of value to obstetricians as it helps to clarify the role of maternal bile acid measurement in evaluation of women with ICP.”