Women successfully treated for severe intrahepatic cholestasis of pregnancy do not have increased risks for adverse perinatal outcomes

摘要

Intrahepatic cholestasis of pregnancy (ICP) increases adverse perinatal outcome (APO) incidence. Whether successful treatment of severe ICP reduces APO risk is unclear. This retrospective, single-center study in China enrolled consecutive women with ICP who had term delivery (≥37 weeks, singleton) between August 2013 and June 2016. Patients were divided into the mild ICP (serum bile acids (SBA) ≤40 μmol/L throughout pregnancy) and severe ICP (SBA 40 μmol/L during pregnancy but fell after ursodeoxycholate therapy) groups. Baseline characteristics, laboratory investigations, and maternal and neonatal outcomes were assessed. Logistic regression was used to identify factors associated with meconium staining of amniotic fluid (MSAF) and APOs. Seventy-three patients were included (mild ICP group, n =47; severe ICP group, n =26). Pruritus was more common in the severe ICP group (65.4% vs 40.4%; P .05), but other baseline characteristics were similar. Compared with the mild ICP group, the severe ICP group had higher SBA at first visit and peak value, higher direct bilirubin before delivery and 4 days postpartum, and lower gamma-glutamyltransferase at peak value, before delivery and 4 days postpartum ( P .05). Other laboratory parameters, type of delivery, hemorrhage, and liver function abnormality were similar between groups, although the severe ICP group had longer duration of hepatic dysfunction ( P .05). Birth weight was lower in the mild ICP group ( P .05), but other fetal outcomes were similar between groups. Logistic regression identified no factors (including SBA group) associated with APOs or MSAF. Women successfully treated for severe ICP do not have increased risks for APOs.