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- Intrahepatic cholestasis of pregnancy (ICP) is characterized by maternal pruritus (itch) and liver dysfunction, with raised total serum bile acid concentrations, in the absence of other contributing liver disorders and restricted to pregnancy.
- The condition is associated with an increased risk of adverse pregnancy outcomes for the newborn, including spontaneous preterm birth, meconium-stained amniotic fluid, neonatal unit admission, and, if the mother's serum bile acid concentrations are elevated to a level of ≥100 micromol/L, stillbirth. Maternal complications include an increased risk of gestational diabetes and preeclampsia, in addition to impaired glucose tolerance and dyslipidemia.
- The only definitive cure is delivery of the baby.
- Pregnant women with total serum bile acid concentrations of <40 micromol/L and mild itching can be offered symptomatic treatment, such as topical emollients and sedating antihistamines. For women with total bile acid concentrations of <100 micromol/L, there is no increased risk of stillbirth compared with the background population, and thus early delivery (before 40 gestational weeks) to prevent stillbirth is not clearly indicated. However, it is important to continue to measure maternal serum bile acid concentrations because they may increase with advancing gestation.
- The risk of stillbirth is increased for pregnant women with total serum bile acid concentrations of ≥100 micromol/L, and so delivery should be offered to these women at 35 to 36 gestational weeks.
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Citations
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