Cholestasis: A Prospective Study of Perinatal Outcomes and Time to Symptom Improvement
| Autor: | Casey S. Yule, Donald D. McIntire, David B. Nelson, Alexandria C. Kraus, Denisse S. Holcomb, Charles E. L. Brown |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty Adolescent Population Gestational Age Cholestasis Intrahepatic Preeclampsia Bile Acids and Salts Young Adult 03 medical and health sciences 0302 clinical medicine Cholestasis Pregnancy medicine Humans Prospective Studies education Prospective cohort study Survival analysis education.field_of_study 030219 obstetrics & reproductive medicine Obstetrics business.industry musculoskeletal neural and ocular physiology Infant Newborn Pregnancy Outcome Obstetrics and Gynecology Gestational age Stillbirth medicine.disease Texas Rash Pregnancy Complications Logistic Models Pediatrics Perinatology and Child Health Premature Birth Female 030211 gastroenterology & hepatology medicine.symptom business Cholestasis of pregnancy |
| Zdroj: | American Journal of Perinatology. 38:414-420 |
| ISSN: | 1098-8785 0735-1631 |
| DOI: | 10.1055/s-0040-1717076 |
| Popis: | Objective Although intrahepatic cholestasis of pregnancy (ICP) remains poorly understood, there are several perinatal complications associated with this condition. This study aimed to examine perinatal outcomes of women with ICP, evaluate outcomes according to severity of disease, and monitor time to symptom improvement following diagnosis. Study Design It involves a prospective, observational study of women with ICP at a single institution. Women with new-onset pruritus without rash were referred to a high-risk obstetrics clinic and evaluated with fasting total bile acids (TBA). Laboratory-confirmed ICP was defined as fasting TBA ≥10 µmol/L. Following diagnosis, a standardized protocol was utilized, including treatment with ursodeoxycholic acid (UDCA). Perinatal outcomes were compared amongst those with and without ICP, and to the general population. Women with ICP were further analyzed based on maximum TBA: 10 to 39, 40 to 99, and ≥100 µmol/L. A Kaplan-Meier survival curve was used to analyze time to symptom improvement. Results A total of 404 patients were evaluated and 212 (52%) were diagnosed with ICP. The mean gestational age at diagnosis was 34.1 ± 3.3 weeks. When comparing those with ICP to those not confirmed, and to the general population, there were no differences in age, parity, mode of delivery, preeclampsia, or stillbirth (p > 0.05). Preterm birth was significantly associated with ICP (p Conclusion Despite treatment with UDCA, women with ICP are at increased risk for spontaneous preterm birth, and this risk significantly increased with severity of disease. Although not significant, a trend exists between increasing time to symptom improvement and worsening severity of disease. Key Points |
| Databáze: | OpenAIRE |
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