ABSTRACT
OBJECTIVE: To determine the risk for adverse pregnancy and fetal outcomes in intrahepatic cholestasis of pregnancy (ICP). DESIGN: Population-based cohort study. SETTING: Swedish Medical Birth Register (MBR) 1997-2009. POPULATION: A total of 1,213,668 singleton deliveries. METHODS: Linkage of Hospital Discharge Register for exposure (ICP; n=5,477) 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, aOR, 2.81; 95% CI 2.32-3.41) and pre-eclampsia (aOR 2.62, 95% CI 2.32-2.78). Women with ICP were also more likely to have spontaneous (aOR 1.60, 95% CI 1.47-1.93) and iatrogenic (aOR 5.95, 95% CI 5.23-6.60) preterm delivery, with increased rates of induction of labour (aOR 11.76, 95% CI 11.04-11.62). However, this actively managed cohort of ICP cases was not at increased risk of stillbirth (aOR 0.92, 95% CI 0.52-1.62). Infants in ICP deliveries were more likely to have a low (<7) 5-minute Apgar score (aOR 1.45, 95% CI 1.14-1.85) and be large for gestational age at birth (aOR 2.27, 95% CI 2.02-2.55). CONCLUSIONS: Over time, a greater proportion of Swedish 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.
Subject(s)
Cholestasis, Intrahepatic/epidemiology , Diabetes, Gestational/epidemiology , Pre-Eclampsia/epidemiology , Pregnancy Complications/epidemiology , Cohort Studies , Female , Humans , Infant, Newborn , Infant, Premature , Pregnancy , Pregnancy Outcome , Risk Factors , Stillbirth , Sweden/epidemiologyABSTRACT
OBJECTIVE: To apply stereology for the detection of possibly morphological abnormalities in placentas of women with intrahepatic cholestasis of pregnancy (ICP). STUDY DESIGN: Prospective case-control study of placentas from untreated and UDCA-treated ICP, respectively, and normal pregnancies, examined for morphological differences by systematic random sampling generated by computerized stereology methodology. MAIN OUTCOME MEASURES: Volume of placenta, surface area of terminal villi and capillaries, volume fraction of collagen, number of syncytial knots, and chorangiosis. RESULTS: Surface area of terminal villi and capillaries, and number of syncytial knots were higher in placentas from all ICP, as compared to controls (p < 0.01). A reduction of collagen was found in placentas from UDCA-treated ICP, both in comparison to placentas from untreated ICP and controls (p < 0.05). CONCLUSION: ICP affects the placenta morphologically as shown by increased terminal villous and capillary surface area, and number of syncytial knots.
