American Journal of Obstetrics and Gynecology
ResearchObstetricsSevere intrahepatic cholestasis of pregnancy is a risk factor for preeclampsia in singleton and twin pregnancies
Section snippets
Setting
This study was conducted at the Tel Aviv Sourasky Medical Center, which is a tertiary referral center with >11,000 deliveries per year. The study was approved by the Institutional Review Board, which waived informed consent.
Study population
In our institution, pregnant women with elevated liver enzymes and/or pruritus are tested routinely for serum TBA levels. In addition, we perform an investigation to rule out preeclampsia, TORCH infection (Toxoplasmosis, Rubella, Cytomegalovirus, Parvo virus, Herpes virus,
Results
The incidence of ICP in our population, (overall –0.1%; 9 per 10,000 deliveries and 121 per 10,000 deliveries for singleton and twins, respectively) is similar to that reported from Canada.5
A total of 78 women with ICP (54 singleton and 24 twin pregnancies) were included in the study group. The obstetric and demographic characteristics of the women in the study and control groups are presented in Table 1. The maternal age of women with singleton pregnancies and ICP was significantly higher than
Comment
We have demonstrated an increased incidence of preeclampsia and of severe preeclampsia among women with ICP in both singleton and twin pregnancies, compared with control subjects, and a correlation with disease severity. The incidence of preeclampsia in our control groups is similar to that reported by Sibai et al.33, 34 Our results are further supported by a recent study in which women with ICP were more likely to experience preeclampsia than were control subjects (adjusted odds ratio, 2.62).7
References (43)
- et al.
Relevance of serum bile acid profile in the diagnosis of intrahepatic cholestasis of pregnancy in a high incidence area: Portugal
Eur J Obstet Gynecol Reprod Biol
(1998) Estrogen cholestasis. Membranes, metabolites or receptors?
Gastroenterology
(1987)- et al.
Intrahepatic cholestasis of pregnancy: molecular pathogenesis, diagnosis and management
J Hepatol
(2000) - et al.
Intrahepatic cholestasis of pregnancy: maternal and fetal outcomes associated with elevated bile acid levels
Am J Obstet Gynecol
(2015) - et al.
Intrahepatic cholestasis of pregnancy: a retrospective case-control study of perinatal outcome
Am J Obstet Gynecol
(1994) - et al.
Obstetric cholestasis: a 14 year review
Am J Obstet Gynecol
(1979) - et al.
Intrahepatic cholestasis of pregnancy: perinatal outcome associated with expectant management
Am J Obstet Gynecol
(1996) - et al.
A prospective study of 18 patients with cholestasis of pregnancy
Am J Obstet Gynecol
(1982) - et al.
Efficacy of ursodeoxycholic acid in treating intrahepatic cholestasis of pregnancy: a meta-analysis
Gastroenterology
(2012) - et al.
Primum non nocere: how active management became modus operandi for intrahepatic cholestasis of pregnancy
Am J Obstet Gynecol
(2014)
Obstetric cholestasis: outcome with active management
Eur J Obstet Gynecol Reprod Biol
Hypertensive disorders in twin versus singleton gestations: National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units
Am J Obstet Gynecol
Pre-eclampsia
Lancet
Review: biochemical markers to predict preeclampsia
Placenta
The biochemical functions of the renal tubules and glomeruli in the course of intrahepatic cholestasis in pregnancy
Eur J Obstet Gynecol Reprod Biol
Hypoxia-induced increase in soluble Flt-1 production correlates with enhanced oxidative stress in trophoblast cells from the human placenta
Placenta
Intrahepatic cholestasis of pregnancy
World J Gastroenterol
Maternal features of obstetric cholestasis: 20years experience at King George V Hospital
Aust N Z J Obstet Gynaecol
Role of bile acid measurement in pregnancy
Ann Clin Biochem
Prevalence of intrahepatic cholestasis of pregnancy in Chile
Ann Intern Med
Intrahepatic cholestasis of pregnancy and associated adverse pregnancy and fetal outcomes: a 12-year population-based cohort study
BJOG
Cited by (62)
Pregnancy outcomes following antenatal screening for intrahepatic cholestasis of pregnancy (ICP)
2023, Taiwanese Journal of Obstetrics and GynecologyTrends in gestational age at delivery for intrahepatic cholestasis of pregnancy and adoption of society guidelines
2022, American Journal of Obstetrics and Gynecology MFMCitation Excerpt :In our adjusted analysis, neonatal outcomes were no worse with advancing GA to 37 weeks in patients with ICP. All patients delivered preterm were significantly more likely than those delivered at term to have another indication prompting delivery, including hypertension, diabetes mellitus, and multiple pregnancy, consistent with data regarding the frequent overlap of ICP with these diagnoses, which may preclude prolonging pregnancy.22 Importantly, the demonstrated effect on NICU admission and adverse neonatal outcomes were observed independently of these comorbid conditions in patients with ICP according to the adjusted analyses performed.
Changes in serum total bile acid concentrations are associated with the risk of developing adverse maternal and perinatal outcomes in pregnant Chinese women
2021, Clinica Chimica ActaCitation Excerpt :A prospective population-based case-control study showed that women with severe ICP and singleton pregnancies were at an increased risk of having a preterm delivery (OR = 5.39, 95% CI: 4.17, 6.98) [35]. Raz et al. demonstrated that severe ICP could significantly increase the risk of developing preeclampsia in both singleton and twin pregnancies [36]. However, previous studies on the association between the TBA concentration and the risk of developing AMPO have only been performed in women with ICP.
The authors report no conflict of interest.
Cite this article as: Raz Y, Lavie A, Vered Y, et al. Severe intrahepatic cholestasis of pregnancy is a risk factor for preeclampsia in singleton and twin pregnancies. Am J Obstet Gynecol 2015;213:395.e1-8.