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Intrahepatic cholestasis of pregnancy and associated adverse pregnancy and fetal outcomes: a 12‐year population‐based cohort study
Author(s) -
Wikström Shemer E,
Marschall HU,
Ludvigsson JF,
Stephansson O
Publication year - 2013
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.12174
Subject(s) - medicine , obstetrics , cholestasis of pregnancy , gestational diabetes , pregnancy , odds ratio , population , small for gestational age , eclampsia , cohort , cholestasis , gestational age , cohort study , premature birth , gestation , fetus , genetics , environmental health , biology
Objective To determine the risk for adverse pregnancy and fetal outcomes in intrahepatic cholestasis of pregnancy ( ICP ). Design Population‐based cohort study. Setting S wedish Medical Birth Register ( MBR ) 1997–2009. Population A total of 1 213 668 singleton deliveries. Methods Linkage of H ospital D ischarge R egister 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, a OR , 2.81; 95% CI 2.32–3.41) and pre‐eclampsia (a OR 2.62, 95% CI 2.32–2.78). Women with ICP were also more likely to have spontaneous (a OR 1.60, 95% CI 1.47–1.93) and iatrogenic (a OR 5.95, 95% CI 5.23–6.60) preterm delivery, with increased rates of induction of labour (a OR 11.76, 95% CI 11.04–11.62). However, this actively managed cohort of ICP cases was not at increased risk of stillbirth (a OR 0.92, 95% CI 0.52–1.62). Infants in ICP deliveries were more likely to have a low (<7) 5‐minute A pgar score (a OR 1.45, 95% CI 1.14–1.85) and be large for gestational age at birth (a OR 2.27, 95% CI 2.02–2.55). Conclusions Over time, a greater proportion of S wedish 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.