Diagnosis and prognosis of early-onset intrahepatic cholestasis of pregnancy: a prospective study

Abstract

Objective: To explore the gestational age of early-onset intrahepatic cholestasis (ICP) of pregnancy, and to analyze the relationship between the clinical biochemical indices and pregnancy outcomes in order to arrive at a reasonable diagnosis and administer appropriate treatment.

Design: This is a retrospective clinical study.

Population or sample: We selected 47,260 pregnant women who received prenatal care and underwent childbirth at the International Peace Maternity and Child Health Hospital affiliated to Shanghai Jiao Tong University from January 2014 to December 2016 for participating in this study. Of these 47,260 women, 407 developed ICP.

Methods: To calculate the gestational week cutoff between early- and late-onset ICP by the receiver-operating characteristic (ROC) curve and Youden’s index. Two independent samples t tests and chi square test were used to compare the differences in biochemical indices and pregnancy outcomes between the two groups.

Results: We found that 34 weeks is the most appropriate cutoff gestational age for the diagnosis of early-onset ICP. Early-onset ICP is characterized by early onset, long disease duration and a higher incidence of preterm labor, fetal distress, and fetal low birth weight compared to late-onset ICP.

Conclusions: Thirty-four weeks is the most appropriate cutoff gestational age for the diagnosis of early-onset ICP. And to reduce the adverse pregnancy outcomes in cases of early-onset ICP, we suggest prolonging gestation up to 37 weeks as far as possible before selecting iatrogenic birth.

Keywords:

• Intrahepatic cholestasis of pregnancy
• early-onset
• fetal distress
• pregnancy outcomes
• bile acids

Acknowledgements

My deepest gratitude goes first and foremost to Dr Gu, for her constant encouragement and guidance. She has walked me through all the stages of the writing of this thesis. Without her consistent and illuminating instruction, this thesis could not have reached its present form. Then my thanks would go to my beloved family for their loving considerations and great confidence in me all through these years. I also owe my sincere gratitude to my friends and my colleagues who gave me their help and time in listening to me and helping me work out my problems during the difficult course of the thesis.

Disclosure statement

We declare that we have no conflict of interest. The manuscript contained a statement that the procedures of the study received ethics approval from the relevant regional or institutional ethics committee. The name of the ethics committee is Ethics Committee of International Peace Maternal and child health hospital. Date of approval is 2/8/2016 and reference number is (GKLW) 2015-61.

Additional information

Funding

This study was funded by the Project of Science and Technology Commission of Shanghai Municipality of China [grant number 15411964200].