Prognosis
Maternal
Pruritus typically resolves rapidly following birth, but it can continue for some weeks postnatally. Underlying liver pathology should be excluded by repeating liver function tests postnatally. Liver function tests and serum bile acids should return to normal by 3 months postnatally. Abnormalities should be investigated according to standard guidelines for patients with abnormal liver function tests, with particular consideration of genetic predispositions for cholestatic pregnancy (such as mutations in ABCB4 and ABCB11).
Population and case-control studies have revealed that women with ICP are more likely to experience subsequent liver disease, in particular cholelithiasis.[17] Women with ICP have an increased risk of hepatobiliary cancer and hepatitis C infection, and slightly higher rates of diabetes mellitus, thyroid disease, psoriasis, inflammatory polyarthropathies, Crohn’s disease, and cardiovascular disease.[105][106]
Fetal
Given the genetic component of the condition, children born to mothers with ICP are more likely to experience pregnancies complicated by the condition. A Swedish population-level study suggested that children of pregnancies complicated by ICP were more likely to develop certain neurodevelopmental disorders (ADHD, autism, or intellectual disability), compared with the background population: 7.2% versus 6.1%, adjusted odds ratio 1.22 (95% CI: 1.13 to 1.31). Although this was attenuated when controlling for gestation of birth, the increased risk persisted for ADHD for patients diagnosed with ICP before 37 gestational weeks.[107] Studies of the North Finland Birth Cohort demonstrated that 16-year-old children born to mothers with ICP have evidence of metabolic impairment: male teenagers had higher body mass indexes and fasting insulin levels, while female teenagers had increased hip and waist girths, and lower high-density lipoprotein cholesterol levels, than the rest of the birth cohort.[108]
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