Surveillance of severe obstetric cholestasis
Previous retrospective case series have suggested that intrahepatic cholestasis of pregnancy (ICP) is associated with adverse fetal outcomes, but there have been concerns over possible biases in these studies. The aim of this study was to describe the pregnancy complications in a national cohort of women with severe ICP and to compare these with pregnancy complications in a cohort of unaffected women and with national rates where available.
- 713 confirmed cases of severe ICP were identified, giving an estimated incidence of 9.2 cases per 10,000 maternities.
- Women with a singleton pregnancy affected by severe ICP (n=669) had increased odds of preterm delivery (adjusted odds ratio (aOR) 5.39, 95% CI 4.17 to 6.98), neonatal unit admission (aOR 2.68, 95% CI 1.97 to 3.65) and stillbirth (aOR 2.58, 95% CI 1.03 to 6.49) compared to control women, and these risks rose with increasing maternal serum bile acid concentrations.
- Seven of the ten stillbirths in ICP cases were associated with co-existing pregnancy complications.
- The risks of preterm delivery (both spontaneous and iatrogenic) and stillbirth were also raised when compared with national data.
- These findings support the case for close antenatal monitoring of pregnancies affected by severe ICP.