Intrahepatic cholestasis of pregnancy
- Overview
- Theory
- Diagnosis
- Management
- Follow up
- Resources
Epidemiology
The prevalence of ICP is influenced by genetic and environmental factors. UK studies typically report rates around 0.7%, with higher rates in women of Indian-Asian and Pakistani-Asian ethnicity.[6]Kenyon AP, Tribe RM, Nelson-Piercy C, et al. Pruritus in pregnancy: a study of anatomical distribution and prevalence in relation to the development of obstetric cholestasis. Obstet Med. 2010 Mar;3(1):25-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989767 http://www.ncbi.nlm.nih.gov/pubmed/27582836?tool=bestpractice.com [22]Abedin P, Weaver JB, Egginton E. Intrahepatic cholestasis of pregnancy: prevalence and ethnic distribution. Ethn Health. 1999 Feb-May;4(1-2):35-7. http://www.ncbi.nlm.nih.gov/pubmed/10887460?tool=bestpractice.com [23]Chappell LC, Gurung V, Seed PT, et al. Ursodeoxycholic acid versus placebo, and early term delivery versus expectant management, in women with intrahepatic cholestasis of pregnancy: semifactorial randomised clinical trial. BMJ. 2012 Jun 13;344:e3799. https://www.bmj.com/content/344/bmj.e3799.long http://www.ncbi.nlm.nih.gov/pubmed/22695903?tool=bestpractice.com Worldwide, the highest rates of disease are seen in Chile (4%), with more recent studies in the US, China, and Australia reporting rates between 0.1% and 2%, and higher rates in women of American Indian and Hispanic ethnicities.[4]Lin J, Gu W, Hou Y. Diagnosis and prognosis of early-onset intrahepatic cholestasis of pregnancy: a prospective study. J Matern Fetal Neonatal Med. 2019 Mar;32(6):997-1003. http://www.ncbi.nlm.nih.gov/pubmed/29065754?tool=bestpractice.com [18]Martineau M, Raker C, Powrie R, et al. Intrahepatic cholestasis of pregnancy is associated with an increased risk of gestational diabetes. Eur J Obstet Gynecol Reprod Biol. 2014 May;176:80-5. http://www.ncbi.nlm.nih.gov/pubmed/24462052?tool=bestpractice.com [24]Reyes H. Sex hormones and bile acids in intrahepatic cholestasis of pregnancy. Hepatology. 2008 Feb;47(2):376-9. https://aasldpubs.onlinelibrary.wiley.com/doi/10.1002/hep.22139 http://www.ncbi.nlm.nih.gov/pubmed/18220280?tool=bestpractice.com [25]Allen AM, Kim WR, Larson JJ, et al. The epidemiology of liver diseases unique to pregnancy in a US community: a population-based study. Clin Gastroenterol Hepatol. 2016 Feb;14(2):287-94. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4718803 http://www.ncbi.nlm.nih.gov/pubmed/26305066?tool=bestpractice.com [26]Marathe JA, Lim WH, Metz MP, et al. A retrospective cohort review of intrahepatic cholestasis of pregnancy in a South Australian population. Eur J Obstet Gynecol Reprod Biol. 2017 Nov;218:33-8. http://www.ncbi.nlm.nih.gov/pubmed/28926728?tool=bestpractice.com [27]Rook M, Vargas J, Caughey A, et al. Fetal outcomes in pregnancies complicated by intrahepatic cholestasis of pregnancy in a Northern California cohort. PLoS One. 2012;7(3):e28343. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3293870 http://www.ncbi.nlm.nih.gov/pubmed/22403605?tool=bestpractice.com [28]Luo XL, Zhang WY. Obstetrical disease spectrum in China: an epidemiological study of 111,767 cases in 2011. Chin Med J (Engl). 2015 May 5;128(9):1137-46. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831537 http://www.ncbi.nlm.nih.gov/pubmed/25947393?tool=bestpractice.com [29]Bull LN, Hu D, Shah S, et al. Intrahepatic cholestasis of pregnancy (ICP) in U.S. Latinas and Chileans: clinical features, ancestry analysis, and admixture mapping. PLoS One. 2015 May 5;10(6):e0131211. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488338 http://www.ncbi.nlm.nih.gov/pubmed/26126184?tool=bestpractice.com [30]Lee RH, Goodwin TM, Greenspoon J, et al. The prevalence of intrahepatic cholestasis of pregnancy in a primarily Latina Los Angeles population. J Perinatol. 2006 Sep;26(9):527-32. http://www.ncbi.nlm.nih.gov/pubmed/16761011?tool=bestpractice.com
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