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Intrahepatic cholestasis of pregnancy — prevalence and ethnic distribution in northern Israel
, 1, 2, 1, 1, 1, 2
Affiliations- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, and Azrieli Faculty of Medicine, Bar Ilan University, Israel
- Liver disease Unit, Galilee Medical Center, Nahariya, and Azrieli Faculty of Medicine, Bar Ilan University, Israel
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Abstract
Objectives: Intrahepatic cholestasis of pregnancy (ICP) is charachterized by pruritis and elevated serum bile acids (BA) and is associated with adverse obstetrical outcomes. ICP etiology is poorly understood and its incidence varies with ethnicity and geographical distribution.
Objectives: Explore the prevalence and characteristics of ICP in the different Northern Israeli ethnic groups and compare maternal and perinatal outcomes according to disease severity.
Material and methods: Single-center retrospective study. Women who were diagnosed with ICP based on clinical presentation and elevated fasting BA (≥ 10 μmol/L) were included. Disease incidence, maternal and neonatal complications were explored according to ethnic subgroups analysis and obstetrical complications were examined according to disease severity.
Results: The incidence of ICP in the study population was 0.58%. Higher ICP incidence was found in our cohort compared with other reports arising from Central Israel (p < 0.001). The Christian patients had a higher incidence of ICP (1.1%) and preeclampsia (23.1%). A higher rate of neonatal intensive care unit (NICU) admissions was found in the Arab Muslim and Christian groups compared with the Jewish and Druze groups (p = 0.007).
A higher rate of preeclampsia was found in the severe (BA ≥ 40 μmol/L) ICP group (p < 0.001). Patients in the severe ICP group had earlier gestational age at delivery (37 versus 38.14 weeks, p < 0.001). Birth weight was significantly lower in the severe ICP group (p = 0.018).
Conclusions: The incidence of ICP at our institution was 0.58%, which is higher compared with previous reported Israeli incidence. Higher ICP and preeclampsia incidence were found among Arab Christian patients.
Abstract
Objectives: Intrahepatic cholestasis of pregnancy (ICP) is charachterized by pruritis and elevated serum bile acids (BA) and is associated with adverse obstetrical outcomes. ICP etiology is poorly understood and its incidence varies with ethnicity and geographical distribution.
Objectives: Explore the prevalence and characteristics of ICP in the different Northern Israeli ethnic groups and compare maternal and perinatal outcomes according to disease severity.
Material and methods: Single-center retrospective study. Women who were diagnosed with ICP based on clinical presentation and elevated fasting BA (≥ 10 μmol/L) were included. Disease incidence, maternal and neonatal complications were explored according to ethnic subgroups analysis and obstetrical complications were examined according to disease severity.
Results: The incidence of ICP in the study population was 0.58%. Higher ICP incidence was found in our cohort compared with other reports arising from Central Israel (p < 0.001). The Christian patients had a higher incidence of ICP (1.1%) and preeclampsia (23.1%). A higher rate of neonatal intensive care unit (NICU) admissions was found in the Arab Muslim and Christian groups compared with the Jewish and Druze groups (p = 0.007).
A higher rate of preeclampsia was found in the severe (BA ≥ 40 μmol/L) ICP group (p < 0.001). Patients in the severe ICP group had earlier gestational age at delivery (37 versus 38.14 weeks, p < 0.001). Birth weight was significantly lower in the severe ICP group (p = 0.018).
Conclusions: The incidence of ICP at our institution was 0.58%, which is higher compared with previous reported Israeli incidence. Higher ICP and preeclampsia incidence were found among Arab Christian patients.
Keywords
intrapartum cholestasis of pregnancy; ethnicity; retrospective cohort review; maternal outcome; perinatal outcome
About this articleTitle
Intrahepatic cholestasis of pregnancy — prevalence and ethnic distribution in northern Israel
Journal
Issue
Article type
Research paper
Pages
578-584
Published online
2021-10-14
Page views
4449
Article views/downloads
720
DOI
Pubmed
Bibliographic record
Ginekol Pol 2022;93(7):578-584.
Keywords
intrapartum cholestasis of pregnancy
ethnicity
retrospective cohort review
maternal outcome
perinatal outcome
Authors
Maya Frank Wolf
Inshirah Sgayer
Liat Yaron
Oleg Shnaider
Marwan Odeh
Jacob Bornstein
Michal Carmiel
References (17)- Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: Relationships between bile acid levels and fetal complication rates. Hepatology. 2004; 40(2): 467–474.
- Kondrackiene J, Beuers U, Zalinkevicius R, et al. Predictors of premature delivery in patients with intrahepatic cholestasis of pregnancy. World J Gastroenterol. 2007; 13(46): 6226–6230.
- Ovadia C, Seed PT, Sklavounos A, et al. Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. Lancet. 2019; 393(10174): 899–909.
- Smith DD, Rood KM. Intrahepatic cholestasis of pregnancy. Clin Obstet Gynecol. 2020; 63(1): 134–151.
- Geenes V, Williamson C. Intrahepatic cholestasis of pregnancy. World J Gastroenterol. 2009; 15(17): 2049–2066.
- Mor M, Shmueli A, Krispin E, et al. Intrahepatic cholestasis of pregnancy as a risk factor for preeclampsia. Arch Gynecol Obstet. 2020; 301(3): 655–664.
- Raz Y, Lavie A, Vered Y, et al. Severe intrahepatic cholestasis of pregnancy is a risk factor for preeclampsia in singleton and twin pregnancies. Am J Obstet Gynecol. 2015; 213(3): 395.e1–395.e8.
- Dollberg S, Haklai Z, Mimouni FB, et al. Birth weight standards in the live-born population in Israel. Isr Med Assoc J. 2005; 7(5): 311–314.
- https://www.cbs.gov.il/he/subjects/Pages/%D7%9C%D7%99%D7%93%D7%95%D7%AA-%D7%97%D7%99.aspx.
- Alghamdi S, Fleckenstein J. Liver disease in pregnancy and transplant. Curr Gastroenterol Rep. 2019; 21(9): 43.
- Li Li, Chen YH, Yang YY, et al. Effect of intrahepatic cholestasis of pregnancy on neonatal birth weight: A meta-analysis. J Clin Res Pediatr Endocrinol. 2018; 10(1): 38–43.
- 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; 176: 80–85.
- Artzi NS, Shilo S, Hadar E, et al. Prediction of gestational diabetes based on nationwide electronic health records. Nat Med. 2020; 26(1): 71–76.
- Prawitt J, Caron S, Staels B. Bile acid metabolism and the pathogenesis of type 2 diabetes. Curr Diab Rep. 2011; 11(3): 160–166.
- Cariou B, Staels B. FXR: a promising target for the metabolic syndrome? Trends Pharmacol Sci. 2007; 28(5): 236–243.
- Estiú MC, Frailuna MA, Otero C, et al. Relationship between early onset severe intrahepatic cholestasis of pregnancy and higher risk of meconium-stained fluid. PLoS One. 2017; 12(4): e0176504.
- Geenes V, Williamson C. Intrahepatic cholestasis of pregnancy. World J Gastroenterol. 2009; 15(17): 2049–2066.
