Jessica A Marathe1, Wei How Lim2, Michael P Metz3, Wendy Scheil4, Gustaaf A Dekker5, William M Hague6. 1. Robinson Research Institute, University of Adelaide, Australia. 2. Women's and Children's Division, Lyell McEwin Hospital, Elizabeth Vale, Australia. 3. SA Pathology Laboratories, Women's and Children's Hospital, Adelaide, Australia; Women's and Children's Hospital Network, Adelaide, Australia. 4. Pregnancy Outcome Unit, SA Department of Health, Adelaide, Australia. 5. Robinson Research Institute, University of Adelaide, Australia; Women's and Children's Division, Lyell McEwin Hospital, Elizabeth Vale, Australia. 6. Robinson Research Institute, University of Adelaide, Australia; Women's and Children's Hospital Network, Adelaide, Australia. Electronic address: bill.hague@adelaide.edu.au.
Abstract
OBJECTIVE: To review the management and outcomes of Intrahepatic Cholestasis of Pregnancy (ICP) in South Australia (SA) over the past decade. DESIGN: Retrospective cohort review. SETTING: Public clinics at two teaching hospitals in SA. POPULATION: All pregnancies associated with ICP (defined as pruritus with serum bile acids≥10μmol/L) managed 2001-2010. METHODS: Identification of subjects (laboratory database), detailed chart-review to ascertain demographics, maternal/perinatal outcomes and associated pregnancy comorbidities, analysis of mild/severe disease cohorts, comparison with normal population data, using Student's t-test or Mann-Whitney U test as appropriate for continuous variables, and Pearson's chi-square test or Fisher's exact test for categorical variables. Unadjusted odds ratios (OR) with 95% confidence intervals (95% CI) were calculated in comparison with the general pregnant population for clinically significant outcomes. RESULTS: 320 women (359 pregnancies) were diagnosed with ICP over the 10-years: incidence 0.6%/year. Within the cohort, the incidences of gestational diabetes (12.5%; OR 3.06, 95% CI 2.23-4.18), pre-eclampsia (10.3%; OR 75.84, 95% CI 52.91-178.70), and spontaneous preterm labour (23.1%; OR 2.05, 95% CI 1.41-2.98) were much higher than in the general SA pregnant population. Pregnancies with severe ICP (serum bile acids≥40μmol/L) had ICP diagnosed earlier (231 vs 248 days, P<0.001), and ended earlier (256 vs 260 days, P<0.001) with lower birthweights (2827g vs 3093g, P <0.001) than those with mild ICP. Neonates of severe ICP mothers were more likely to require special-care-nursery admission, but perinatal complication rates did not differ. There were no stillbirths. CONCLUSION: This large Australian retrospective cohort study confirms generally favourable outcomes associated with ICP, mild or severe, with no stillbirths, likely secondary to proactive medical management. A high proportion of pregnancies were also affected by gestational diabetes, pre-eclampsia, and/or spontaneous pre-term labour compared with the general population.
OBJECTIVE: To review the management and outcomes of Intrahepatic Cholestasis of Pregnancy (ICP) in South Australia (SA) over the past decade. DESIGN: Retrospective cohort review. SETTING: Public clinics at two teaching hospitals in SA. POPULATION: All pregnancies associated with ICP (defined as pruritus with serum bile acids≥10μmol/L) managed 2001-2010. METHODS: Identification of subjects (laboratory database), detailed chart-review to ascertain demographics, maternal/perinatal outcomes and associated pregnancy comorbidities, analysis of mild/severe disease cohorts, comparison with normal population data, using Student's t-test or Mann-Whitney U test as appropriate for continuous variables, and Pearson's chi-square test or Fisher's exact test for categorical variables. Unadjusted odds ratios (OR) with 95% confidence intervals (95% CI) were calculated in comparison with the general pregnant population for clinically significant outcomes. RESULTS: 320 women (359 pregnancies) were diagnosed with ICP over the 10-years: incidence 0.6%/year. Within the cohort, the incidences of gestational diabetes (12.5%; OR 3.06, 95% CI 2.23-4.18), pre-eclampsia (10.3%; OR 75.84, 95% CI 52.91-178.70), and spontaneous preterm labour (23.1%; OR 2.05, 95% CI 1.41-2.98) were much higher than in the general SA pregnant population. Pregnancies with severe ICP (serum bile acids≥40μmol/L) had ICP diagnosed earlier (231 vs 248 days, P<0.001), and ended earlier (256 vs 260 days, P<0.001) with lower birthweights (2827g vs 3093g, P <0.001) than those with mild ICP. Neonates of severe ICP mothers were more likely to require special-care-nursery admission, but perinatal complication rates did not differ. There were no stillbirths. CONCLUSION: This large Australian retrospective cohort study confirms generally favourable outcomes associated with ICP, mild or severe, with no stillbirths, likely secondary to proactive medical management. A high proportion of pregnancies were also affected by gestational diabetes, pre-eclampsia, and/or spontaneous pre-term labour compared with the general population.
Authors: Caroline Ovadia; Paul T Seed; Alexandros Sklavounos; Victoria Geenes; Chiara Di Ilio; Jenny Chambers; Katherine Kohari; Yannick Bacq; Nuray Bozkurt; Romana Brun-Furrer; Laura Bull; Maria C Estiú; Monika Grymowicz; Berrin Gunaydin; William M Hague; Christian Haslinger; Yayi Hu; Tetsuya Kawakita; Ayse G Kebapcilar; Levent Kebapcilar; Jūratė Kondrackienė; Maria P H Koster; Aneta Kowalska-Kańka; Limas Kupčinskas; Richard H Lee; Anna Locatelli; Rocio I R Macias; Hanns-Ulrich Marschall; Martijn A Oudijk; Yael Raz; Eli Rimon; Dan Shan; Yong Shao; Rachel Tribe; Valeria Tripodi; Cigdem Yayla Abide; Ilter Yenidede; Jim G Thornton; Lucy C Chappell; Catherine Williamson Journal: Lancet Date: 2019-02-14 Impact factor: 202.731
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