Intrahepatic cholestasis of pregnancy: Maternal and fetal outcomes associated with elevated bile acid levels

Laura Brouwers; Maria P.H. Koster; Godelieve C.M.L. Page-Christiaens; Hans Kemperman; Janine Boon; Inge M. Evers; Auke Bogte; Martijn A. Oudijk

doi:10.1016/j.ajog.2014.07.026

Intrahepatic cholestasis of pregnancy: Maternal and fetal outcomes associated with elevated bile acid levels

Laura Brouwers, Maria P.H. Koster, Godelieve C.M.L. Page-Christiaens, Hans Kemperman, Janine Boon, Inge M. Evers, Auke Bogte, Martijn A. Oudijk^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Objective The primary aim of this study was to investigate the correlation between pregnancy outcome and bile acid (BA) levels in pregnancies that were affected by intrahepatic cholestasis of pregnancy (ICP). In addition, correlations between maternal and fetal BA levels were explored.

Study Design We conducted a retrospective study that included women with pruritus and BA levels ≥10 μmol/L between January 2005 and August 2012 in 3 large hospitals in the Netherlands. The study group was divided in mild (10-39 μmol/L), moderate (40-99 μmol/L), and severe (≥100 μmol/L) ICP. Main outcome measures were spontaneous preterm birth, meconium-stained amniotic fluid, asphyxia, and perinatal death. Univariate and multivariate logistic regression analysis was used to study associations between BA levels and adverse outcome.

Results A total of 215 women were included. Gestational age at diagnosis and gestational age at delivery were significantly lower in the severe, as compared with the mild, ICP group (P <.001). Spontaneous preterm birth (19.0%), meconium-stained fluid (47.6%), and perinatal death (9.5%) occurred significantly more often in cases with severe ICP. Higher BA levels were associated significantly with spontaneous preterm birth (adjusted odds ratio [aOR], 1.15; 95% confidence interval [CI], 1.03-1.28), meconium-stained amniotic fluid (aOR, 1.15; 95% CI, 1.06-1.25), and perinatal death (aOR, 1.26; 95% CI, 1.01-1.57). Maternal BA levels at diagnosis and at delivery were correlated positively with umbilical cord blood BA levels (P =.006 and.012, respectively).

Conclusion Severe ICP is associated with adverse pregnancy outcome. Levels of BA correlate between mother and fetus.

Original language	English
Pages (from-to)	100.e1-100.e7
Journal	American Journal of Obstetrics and Gynecology
Volume	212
Issue number	1
DOIs	https://doi.org/10.1016/j.ajog.2014.07.026 https://doi.org/10.1016/j.ajog.2014.07.026
Publication status	Published - 1 Jan 2015

Keywords

adverse pregnancy outcome
bile acid
intrahepatic cholestasis
perinatal death

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Brouwers, L., Koster, M. P. H., Page-Christiaens, G. C. M. L., Kemperman, H., Boon, J., Evers, I. M., Bogte, A., & Oudijk, M. A. (2015). Intrahepatic cholestasis of pregnancy: Maternal and fetal outcomes associated with elevated bile acid levels. American Journal of Obstetrics and Gynecology, 212(1), 100.e1-100.e7. https://doi.org/10.1016/j.ajog.2014.07.026, https://doi.org/10.1016/j.ajog.2014.07.026

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title = "Intrahepatic cholestasis of pregnancy: Maternal and fetal outcomes associated with elevated bile acid levels",

abstract = "Objective The primary aim of this study was to investigate the correlation between pregnancy outcome and bile acid (BA) levels in pregnancies that were affected by intrahepatic cholestasis of pregnancy (ICP). In addition, correlations between maternal and fetal BA levels were explored.Study Design We conducted a retrospective study that included women with pruritus and BA levels ≥10 μmol/L between January 2005 and August 2012 in 3 large hospitals in the Netherlands. The study group was divided in mild (10-39 μmol/L), moderate (40-99 μmol/L), and severe (≥100 μmol/L) ICP. Main outcome measures were spontaneous preterm birth, meconium-stained amniotic fluid, asphyxia, and perinatal death. Univariate and multivariate logistic regression analysis was used to study associations between BA levels and adverse outcome.Results A total of 215 women were included. Gestational age at diagnosis and gestational age at delivery were significantly lower in the severe, as compared with the mild, ICP group (P <.001). Spontaneous preterm birth (19.0%), meconium-stained fluid (47.6%), and perinatal death (9.5%) occurred significantly more often in cases with severe ICP. Higher BA levels were associated significantly with spontaneous preterm birth (adjusted odds ratio [aOR], 1.15; 95% confidence interval [CI], 1.03-1.28), meconium-stained amniotic fluid (aOR, 1.15; 95% CI, 1.06-1.25), and perinatal death (aOR, 1.26; 95% CI, 1.01-1.57). Maternal BA levels at diagnosis and at delivery were correlated positively with umbilical cord blood BA levels (P =.006 and.012, respectively).Conclusion Severe ICP is associated with adverse pregnancy outcome. Levels of BA correlate between mother and fetus.",

keywords = "adverse pregnancy outcome, bile acid, intrahepatic cholestasis, perinatal death",

author = "Laura Brouwers and Koster, {Maria P.H.} and Page-Christiaens, {Godelieve C.M.L.} and Hans Kemperman and Janine Boon and Evers, {Inge M.} and Auke Bogte and Oudijk, {Martijn A.}",

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doi = "10.1016/j.ajog.2014.07.026",

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Brouwers, L, Koster, MPH, Page-Christiaens, GCML, Kemperman, H, Boon, J, Evers, IM, Bogte, A & Oudijk, MA 2015, 'Intrahepatic cholestasis of pregnancy: Maternal and fetal outcomes associated with elevated bile acid levels', American Journal of Obstetrics and Gynecology, vol. 212, no. 1, pp. 100.e1-100.e7. https://doi.org/10.1016/j.ajog.2014.07.026, https://doi.org/10.1016/j.ajog.2014.07.026

TY - JOUR

T1 - Intrahepatic cholestasis of pregnancy

T2 - Maternal and fetal outcomes associated with elevated bile acid levels

AU - Brouwers, Laura

AU - Koster, Maria P.H.

AU - Page-Christiaens, Godelieve C.M.L.

AU - Kemperman, Hans

AU - Boon, Janine

AU - Evers, Inge M.

AU - Bogte, Auke

AU - Oudijk, Martijn A.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Objective The primary aim of this study was to investigate the correlation between pregnancy outcome and bile acid (BA) levels in pregnancies that were affected by intrahepatic cholestasis of pregnancy (ICP). In addition, correlations between maternal and fetal BA levels were explored.Study Design We conducted a retrospective study that included women with pruritus and BA levels ≥10 μmol/L between January 2005 and August 2012 in 3 large hospitals in the Netherlands. The study group was divided in mild (10-39 μmol/L), moderate (40-99 μmol/L), and severe (≥100 μmol/L) ICP. Main outcome measures were spontaneous preterm birth, meconium-stained amniotic fluid, asphyxia, and perinatal death. Univariate and multivariate logistic regression analysis was used to study associations between BA levels and adverse outcome.Results A total of 215 women were included. Gestational age at diagnosis and gestational age at delivery were significantly lower in the severe, as compared with the mild, ICP group (P <.001). Spontaneous preterm birth (19.0%), meconium-stained fluid (47.6%), and perinatal death (9.5%) occurred significantly more often in cases with severe ICP. Higher BA levels were associated significantly with spontaneous preterm birth (adjusted odds ratio [aOR], 1.15; 95% confidence interval [CI], 1.03-1.28), meconium-stained amniotic fluid (aOR, 1.15; 95% CI, 1.06-1.25), and perinatal death (aOR, 1.26; 95% CI, 1.01-1.57). Maternal BA levels at diagnosis and at delivery were correlated positively with umbilical cord blood BA levels (P =.006 and.012, respectively).Conclusion Severe ICP is associated with adverse pregnancy outcome. Levels of BA correlate between mother and fetus.

AB - Objective The primary aim of this study was to investigate the correlation between pregnancy outcome and bile acid (BA) levels in pregnancies that were affected by intrahepatic cholestasis of pregnancy (ICP). In addition, correlations between maternal and fetal BA levels were explored.Study Design We conducted a retrospective study that included women with pruritus and BA levels ≥10 μmol/L between January 2005 and August 2012 in 3 large hospitals in the Netherlands. The study group was divided in mild (10-39 μmol/L), moderate (40-99 μmol/L), and severe (≥100 μmol/L) ICP. Main outcome measures were spontaneous preterm birth, meconium-stained amniotic fluid, asphyxia, and perinatal death. Univariate and multivariate logistic regression analysis was used to study associations between BA levels and adverse outcome.Results A total of 215 women were included. Gestational age at diagnosis and gestational age at delivery were significantly lower in the severe, as compared with the mild, ICP group (P <.001). Spontaneous preterm birth (19.0%), meconium-stained fluid (47.6%), and perinatal death (9.5%) occurred significantly more often in cases with severe ICP. Higher BA levels were associated significantly with spontaneous preterm birth (adjusted odds ratio [aOR], 1.15; 95% confidence interval [CI], 1.03-1.28), meconium-stained amniotic fluid (aOR, 1.15; 95% CI, 1.06-1.25), and perinatal death (aOR, 1.26; 95% CI, 1.01-1.57). Maternal BA levels at diagnosis and at delivery were correlated positively with umbilical cord blood BA levels (P =.006 and.012, respectively).Conclusion Severe ICP is associated with adverse pregnancy outcome. Levels of BA correlate between mother and fetus.

KW - adverse pregnancy outcome

KW - bile acid

KW - intrahepatic cholestasis

KW - perinatal death

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U2 - 10.1016/j.ajog.2014.07.026

DO - 10.1016/j.ajog.2014.07.026

M3 - Article

C2 - 25046809

AN - SCOPUS:84919331335

SN - 0002-9378

VL - 212

SP - 100.e1-100.e7

JO - American Journal of Obstetrics and Gynecology

JF - American Journal of Obstetrics and Gynecology

IS - 1

ER -

Intrahepatic cholestasis of pregnancy: Maternal and fetal outcomes associated with elevated bile acid levels

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