Maternal and perinatal outcome in cholestasis of pregnancy: a study in tertiary care hospital in North India
Keywords:Fetal complications, Fetal outcome, Intrahepatic cholestasis of pregnancy (IHCP), Maternal outcome, Obstetric, Pregnancy
Background: Intrahepatic cholestasis of pregnancy (IHCP) is the most common pregnancy related liver disorder. It typically presents with troublesome itching and can lead to complications for both mother and fetus. Thus, authors aimed to assess risk factors associated with IHCP as well as maternal and fetal outcome in pregnancy associated with IHCP in north Indian population.
Methods: This hospital based analytical observational case control study enrolled 44 subjects with IHCP and 44 normal healthy pregnant controls. The subjects were assessed for demographic parameters, obstetric history, liver function tests including Bile acids. Outcome was measured as various parameters related to delivery and maternal and fetal complications.
Results: Study groups were matched for age (0.52). Frequency of primipara was higher in IHCP (p=0.01). Serum bilirubin (p=0.002), liver enzymes (p<0.0001 for all) and Bile acids (p=0.001) were significantly elevated in IHCP subjects compared to controls. Further, frequency of preterm birth was higher in IHCP (p=0.013). Fetal complications (p=0.01) and birth weight (p=0.03) were higher in IHCP subjects.
Conclusions: IHCP is associated with higher risk of complications in infants and to lesser extent in mothers.
Van Wettere AJ. Histologic patterns of hepatotoxic injury. Comprehensive Toxicol. 2018;2:97-136.
Kenyon AP, Piercy CN, Girling J, Williamson C, Tribe RM, Shennan AH. Pruritus may precede abnormal liver function tests in pregnant women with obstetric cholestasis: a longitudinal analysis. BJOG. 2001;108(11):1190-2.
Ghosh S, Chaudhuri S. Intra-hepatic cholestasis of pregnancy: a comprehensive review. Indian J Dermatol. 2013;58(4):327.
Pusl T, Beuers U. Intrahepatic cholestasis of pregnancy. Orphanet J Rare Dis. 2007;2:26.
Geenes V, Chappell L, Seed P, Steer P, Knight M, Williamson C. Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: A prospective population-based case-control study. Hepatol. 2014;59(4):1482-91.
Al Shobaili H, Hamed H, Al Robaee A, Alzolibani A, Amin A, Ahmad S. Obstetrical and fetal outcomes of a new management strategy in patients with intra-hepatic cholestasis of pregnancy. Arch Gynecol Obstet. 2010;283(6):1219-25.
Reyes H. Review: intrahepatic cholestasis. A puzzling disorder of pregnancy. J Gastroenterol Hepatol. 1997;12:212-6.
Lammert F, Marschall H, Glantz A, Matern S. Intrahepatic cholestasis of pregnancy: molecular pathogenesis, diagnosis and management. J Hepatol. 2000;33(6):1012-21.
Bacq Y, Sapey T, Bréchot MC, Pierre F, Fignon A, Dubois F. Intrahepatic cholestasis of pregnancy: a French prospective study. Hepatol. 1997;26(2):358-64.
Brouwers L, Koster M, Page-Christiaens G, Kemperman H, Boon J, Evers I, et al. Intrahepatic cholestasis of pregnancy: maternal and fetal outcomes associated with elevated bile acid levels. Am J Obstet Gynecol. 2015;212(1):100.e1-7.
Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: Relationships between bile acid levels and fetal complication rates. Hepatol. 2004;40:467-74.
Dang A, Agarwal N, Bathla S, Sharma N, Balani S. Prevalence of liver disease in pregnancy and its outcome with emphasis on obstetric cholestasis: An Indian scenario. J Obstet Gynecol India. 2010;60(5):413.
Wikström Shemer E, Marschall H, Ludvigsson J, Stephansson O. Intrahepatic cholestasis of pregnancy and associated adverse pregnancy and fetal outcomes: a 12-year population-based cohort study. BJOG. 2013;120(6):717-23.
Wikström Shemer E, Thorsell M, Marschall H, Kaijser M. Risks of emergency cesarean section and fetal asphyxia after induction of labor in intrahepatic cholestasis of pregnancy: A hospital-based retrospective cohort study. Sexual Reproductive Healthcare. 2013;4(1):17-22.
Geenes V, Chambers J, Khurana R, Shemer E, Sia W, Mandair D, et al. Rifampicin in the treatment of severe intrahepatic cholestasis of pregnancy. Eur J Obstet Gynecol Reprod Bio. 2015;189:59-63.
Cavazos-Rehg PA, Krauss MJ, Spitznagel EL, Bommarito K, Madden T, Olsen MA, et al. Maternal age and risk of labor and delivery complications. Maternal Child Health J. 2015;19(6):1202-11.
Heinonen S, Kirkinen P. Pregnancy outcome with intrahepatic cholestasis. Obstet Gynecol. 1999;94(2):189-93.
Laatikainen T, Tulenheimo A. Maternal serum bile acid levels and fetal distress in cholestasis of pregnancy. Int J Gynaecol Obstet. 1984;22:91-4.
Zimmermann P, Koskinen J, Vaalamo P, Ranta T. Doppler umbilical artery velocimetry in pregnancies complicated by intrahepatic cholestasis. J Perinat Med. 1991;19:351-5.
Simpson LL. Maternal medical disease: risk of antepartum fetal death. Semin Perinatol. 2002;26:42-50.