Diagnosis and prognosis of early-onset intrahepatic cholestasis of pregnancy: a prospective study

J Matern Fetal Neonatal Med. 2019 Mar;32(6):997-1003. doi: 10.1080/14767058.2017.1397124. Epub 2017 Nov 7.

Abstract

Objective: To explore the gestational age of early-onset intrahepatic cholestasis (ICP) of pregnancy, and to analyze the relationship between the clinical biochemical indices and pregnancy outcomes in order to arrive at a reasonable diagnosis and administer appropriate treatment.

Design: This is a retrospective clinical study.

Population or sample: We selected 47,260 pregnant women who received prenatal care and underwent childbirth at the International Peace Maternity and Child Health Hospital affiliated to Shanghai Jiao Tong University from January 2014 to December 2016 for participating in this study. Of these 47,260 women, 407 developed ICP.

Methods: To calculate the gestational week cutoff between early- and late-onset ICP by the receiver-operating characteristic (ROC) curve and Youden's index. Two independent samples t tests and chi square test were used to compare the differences in biochemical indices and pregnancy outcomes between the two groups.

Results: We found that 34 weeks is the most appropriate cutoff gestational age for the diagnosis of early-onset ICP. Early-onset ICP is characterized by early onset, long disease duration and a higher incidence of preterm labor, fetal distress, and fetal low birth weight compared to late-onset ICP.

Conclusions: Thirty-four weeks is the most appropriate cutoff gestational age for the diagnosis of early-onset ICP. And to reduce the adverse pregnancy outcomes in cases of early-onset ICP, we suggest prolonging gestation up to 37 weeks as far as possible before selecting iatrogenic birth.

Keywords: Intrahepatic cholestasis of pregnancy; bile acids; early-onset; fetal distress; pregnancy outcomes.

MeSH terms

  • Adult
  • Cholestasis, Intrahepatic / diagnosis*
  • Cholestasis, Intrahepatic / epidemiology
  • Cholestasis, Intrahepatic / therapy
  • Female
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Pregnancy
  • Pregnancy Complications / diagnosis*
  • Pregnancy Complications / epidemiology
  • Pregnancy Complications / therapy
  • Pregnancy Outcome / epidemiology*
  • Premature Birth / epidemiology*
  • Prospective Studies
  • Retrospective Studies
  • Severity of Illness Index*

Supplementary concepts

  • Intrahepatic Cholestasis of Pregnancy