Fetal outcomes in pregnancies complicated by intrahepatic cholestasis of pregnancy in a Northern California cohort

Michelle Rook, Juan Vargas, Aaron Caughey, Peter Bacchetti, Philip Rosenthal, Laura Bull

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Background: Intrahepatic cholestasis of pregnancy (ICP) has important fetal implications. There is increased risk for poor fetal outcomes, including preterm delivery, meconium staining of amniotic fluid, respiratory distress, fetal distress and demise. Methods: One hundred and one women diagnosed with ICP between January 2005 and March 2009 at San Francisco General Hospital were included in this study. Single predictor logistic regression models were used to assess the associations of maternal clinical and biochemical predictors with fetal complications. Clinical predictors analyzed included age, race/ethnicity, gravidity, parity, history of liver or biliary disease, history of ICP in previous pregnancies, and induction. Biochemical predictors analyzed included serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total bilirubin, direct bilirubin, albumin, total protein, and total bile acids (TBA). Results: The prevalence of ICP was 1.9%. Most were Latina (90%). Labor was induced in the majority (87%) and most were delivered by normal spontaneous vaginal delivery (84%). Fetal complications occurred in 33% of the deliveries, with respiratory distress accounting for the majority of complications. There were no statistically significant clinical or biochemical predictors associated with an increased risk of fetal complications. Elevated TBA had little association with fetal complications until reaching greater than 100 μmoL/L, with 3 out of 5 having reported complications. ICP in previous pregnancies was associated with decreased risk of fetal complications (OR 0.21, p = 0.046). There were no cases of late term fetal demise. Conclusions: Maternal clinical and laboratory features, including elevated TBA, did not appear to be substantial predictors of fetal complications in ICP.

Original languageEnglish (US)
Article numbere28343
JournalPLoS One
Volume7
Issue number3
DOIs
StatePublished - Mar 5 2012
Externally publishedYes

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pregnancy outcome
Pregnancy Outcome
Bile Acids and Salts
pregnancy
Bilirubin
bile acids
Fetal Death
distress
Aspartate Aminotransferases
Alanine Transaminase
Liver
Alkaline Phosphatase
Logistics
Albumins
bilirubin
Logistic Models
Mothers
Personnel
Induced Labor
Gravidity

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Fetal outcomes in pregnancies complicated by intrahepatic cholestasis of pregnancy in a Northern California cohort. / Rook, Michelle; Vargas, Juan; Caughey, Aaron; Bacchetti, Peter; Rosenthal, Philip; Bull, Laura.

In: PLoS One, Vol. 7, No. 3, e28343, 05.03.2012.

Research output: Contribution to journalArticle

Rook, Michelle ; Vargas, Juan ; Caughey, Aaron ; Bacchetti, Peter ; Rosenthal, Philip ; Bull, Laura. / Fetal outcomes in pregnancies complicated by intrahepatic cholestasis of pregnancy in a Northern California cohort. In: PLoS One. 2012 ; Vol. 7, No. 3.
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