[Intrahepatic cholestasis of pregnancy and fetal outcomes: a prospective birth cohort study]

To evaluate the relations between the second and third trimesters intrahepatic cholestasis of pregnancy (ICP) and the fetal outcomes, in order to provide medical advice for early detection and intervention on ICP.

A prospective cohort study was conducted in Ma' anshan, Anhui, China (Ma'anshan Birth Cohort, MABC). Pregnant women within 14 weeks of gestation were consecutively recruited when standards were met. Anthropometrics were collected in early pregnancy. Maternal serum total bile acid level (TBA) was collected in the second and third trimesters, and women were viewed as cases if the results were accorded with clinical diagnosis. Logistic regressions were conducted to examine the associations of the second and third trimester ICP, and fetal outcomes.

A total of 2 978 pregnant women were included in this study. The rate of ICP was 6.5% (n=196), and the rates of the second and third trimesters were 1.4% (n=43) and 5.1% (n=153) respectively. After controlling for potential confounders, we found that ICP from both the second and third trimesters could increase the risks of preterm birth, low birth weight (LBW), fetal distress and meconium-stained amniotic fluid.OR values (95% CI) were 6.42 (2.59-15.93) and 3.73 (2.07-6.72) for preterm birth while 6.52 (2.19-19.45) and 4.90 (2.43-9.90) for LBW, 2.91 (1.27-6.67) and 1.88 (1.11-3.19) for fetal distress and 2.34 (1.19-4.61) and 1.66 (1.11-2.48) for meconium-stained amniotic fluids, respectively. The risk of adverse fetal outcomes caused by the second trimester ICP appeared significantly higher than the third trimester ICP.

ICP from the second and third trimesters significantly increased the risk of adverse fetal outcomes, suggesting that clinicians should put more attention to the second trimester ICP. Both early detection and intervention were of great importance in reducing the adverse fetal outcomes.