Understanding the management of pregnancies with intrahepatic cholestasis of pregnancy (ICP)
Background
Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder that affects 1 in 200 pregnancies. This study looked at the effects on the baby where there was severe ICP during pregnancy. It found that women who had severe ICP were more likely to have a stillborn baby, to deliver their baby early, or have a baby who needed support in the neonatal unit.
This study looked at national data to learn about the relationship between severe ICP and problems in pregnancy. The researchers wanted to test whether babies were more likely to be stillborn or seriously unwell if their mothers had severe ICP.
The findings showed that women with severe ICP were more likely to have a stillborn baby, to deliver their baby early or have a baby who needed support in the neonatal unit. Most of the women whose babies were stillborn had other pregnancy complications, so the results are not completely straightforward. But they are clear enough to show that women with severe ICP should be offered extra monitoring in their pregnancies.
More information
Why was this research needed?
Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder also known as obstetric cholestasis (OC). High levels of bile acids in the mother’s blood cause symptoms including itching, which is usually most noticeable in the hands and feet. It affects around 5,500 women a year in the UK, and is associated with problems in pregnancy including early labour, and babies who are stillborn or seriously unwell.
What were the aims of this study?
To produce high-quality evidence about the relationship between severe ICP and problems in pregnancy, and to test whether babies were more likely to be stillborn or seriously unwell if their mothers had severe ICP.
What did the researchers do?
In this study funded by Sands, the researchers identified 669 women who had severe ICP and were pregnancy with one baby and took blood samples during their pregnancies. They also collected information about how the women were looked after, any pregnancy problems, and their babies’ health. Through this approach, the researchers could show how higher levels of bile acids increased certain risks for women and babies, including early labour, stillbirth, and babies who were very unwell at the time of birth.
What did we expect from the study?
Before this study, there was not enough strong evidence about the relationship between ICP and pregnancy problems to know how best to care for women with ICP in pregnancy. This large study shows that there are significant increased risks of some pregnancy problems for women with severe ICP. Compared to women who had uncomplicated pregnancies, the women in this study with severe ICP had increased risks of preterm birth and stillbirth, and their babies were more likely to be admitted to the neonatal unit. Most of the women whose babies were stillborn had other pregnancy complications, so the results are not completely straightforward. But they are clear enough to show that women with severe ICP should be offered extra monitoring in their pregnancies.
Additional information:
Lead researcher – Professor Catherine Williamson
Institution –Institute of Reproductive and Developmental Biology, Imperial College London
Funder – Sands, Wellbeing of Women Charity
Duration – June 2010 to May 2011
Publications:
Geenes, V., Chappell, L.C., Seed, P.T., Steer, P.J., Knight, M., Williamson, C. (2014) Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: a prospective population-based case-control study. Hepatology, 59(4), 1482-91. DOI: 10.1002/hep.26617 https://pubmed.ncbi.nlm.nih.gov/23857305/
Ovadia, C., Seed, P.T., Sklavounos, A. et al. (2019) Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses The Lancet, 393(10174), 899 – 909. DOI: 10.1016/S0140-6736(18)31877-4 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31877-4/fulltext
Ovadia, C., Sajous, J., Seed, P.T et al. (2021) Ursodeoxycholic acid in intrahepatic cholestasis of pregnancy: a systematic review and individual participant data meta-analysis. The Lancet Gastroenterology & Hepatology, 6(7), 547-558. DOI: 10.1016/S2468-1253(21)00074-1 https://www.thelancet.com/journals/langas/article/PIIS2468-1253(21)00074-1/fulltext