Intrahepatic cholestasis of pregnancy and associated adverse pregnancy and fetal outcomes: a 12-year population-based cohort study

Authors

  • E Wikström Shemer,

    1. Department of Obstetrics and Gynaecology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
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  • HU Marschall,

    Corresponding author
    1. Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
    • Department of Obstetrics and Gynaecology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
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  • JF Ludvigsson,

    1. Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital and Institutet, Stockholm, Sweden
    2. Department of Paediatrics, Örebro University Hospital, Örebro, Sweden
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  • O Stephansson

    1. Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital and Institutet, Stockholm, Sweden
    2. Department of Women's and Children's Health, Karolinska University Hospital and Institutet, Stockholm, Sweden
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Correspondence: Dr HU Marschall, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, S-41345 Gothenburg, Sweden. Email hanns-ulrich.marschall@gu.se

Abstract

Objective

To determine the risk for adverse pregnancy and fetal outcomes in intrahepatic cholestasis of pregnancy (ICP).

Design

Population-based cohort study.

Setting

Swedish Medical Birth Register (MBR) 1997–2009.

Population

A total of 1 213 668 singleton deliveries.

Methods

Linkage of Hospital Discharge Register for exposure (ICP; n = 5477) with MBR for covariates.

Main outcome measures

Gestational diabetes, pre-eclampsia, prematurity, and stillbirth.

Results

Intrahepatic cholestasis (ICP) was diagnosed in 0.32–0.58% of all pregnancies, with an increasing trend until 2005 (P < 0.0001). Compared with women who did not have ICP, women with ICP were more likely to have gestational diabetes (adjusted odds ratio, aOR, 2.81; 95% CI 2.32–3.41) and pre-eclampsia (aOR 2.62, 95% CI 2.32–2.78). Women with ICP were also more likely to have spontaneous (aOR 1.60, 95% CI 1.47–1.93) and iatrogenic (aOR 5.95, 95% CI 5.23–6.60) preterm delivery, with increased rates of induction of labour (aOR 11.76, 95% CI 11.04–11.62). However, this actively managed cohort of ICP cases was not at increased risk of stillbirth (aOR 0.92, 95% CI 0.52–1.62). Infants in ICP deliveries were more likely to have a low (<7) 5-minute Apgar score (aOR 1.45, 95% CI 1.14–1.85) and be large for gestational age at birth (aOR 2.27, 95% CI 2.02–2.55).

Conclusions

Over time, a greater proportion of Swedish pregnant women have received a diagnosis of ICP, probably because of an increased awareness of the disorder. Our data confirm an increased risk of preterm delivery, but not of stillbirth, in actively managed ICP. The high rates of gestational diabetes and pre-eclampsia are new findings, and need to be considered in the management of ICP pregnancies.

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