Gregorc Petra, Verdenik Ivan, Pečlin Polona
Division of Obstetrics and Gynaecology, Department of Perinatology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia.
Department of Gynaecology and Obstetrics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia.
Diagnostics (Basel). 2025 Aug 28;15(17):2185. doi: 10.3390/diagnostics15172185.
: Intrahepatic cholestasis of pregnancy (ICP) is the most common reversible liver disorder linked to pregnancy, characterised by pruritus and elevated serum bile acids (BAs). Condition severity correlates with increased maternal and neonatal complications, and recent evidence highlights a significantly elevated risk of adverse perinatal outcomes, including stillbirth, when BA > 100 µmol/L. : This retrospective study, conducted at a tertiary perinatology centre between 2019 and 2023, was performed in two phases. In the first phase, baseline group characteristics and pregnancy outcomes were compared between ICP and non-ICP (control) groups. In the second phase, outcomes were analysed across three ICP severity subgroups: mild (BA < 40 µmol/L), moderate (BA 40-99 µmol/L), and severe (BA ≥ 100 µmol/L). : A total of 210 patients diagnosed with ICP and 24,177 controls were included in the analysis. After multivariable regression, the results indicated that patients with severe ICP (BA ≥ 100 µmol/L) experienced significantly worse perinatal outcomes compared to those with mild or moderate disease: spontaneous preterm birth occurred in 26.7% of cases ( = 0.002), iatrogenic preterm birth in 36.7% ( < 0.001), meconium-stained amniotic fluid in 43.3% ( = 0.001), and neonatal intensive care unit (NICU) admission in 23.3% ( = 0.006). This subgroup also had the lowest mean birth weight (2830 g, < 0.001). Notably, no stillbirths were recorded in any of the subgroups. Compared to controls, no major differences in maternal characteristics were noted, except in pregnancies conceived via in vitro fertilisation (IVF, = 0.012) and those complicated by gestational diabetes ( = 0.040), both showing elevated risk for ICP development. : This study confirms an association between ICP and increased perinatal complications, with severity of disease correlating with poorer outcomes. The findings highlight the need for standardised BA testing and improved strategies for perinatal management.
妊娠肝内胆汁淤积症（ICP）是与妊娠相关的最常见的可逆性肝脏疾病，其特征为瘙痒和血清胆汁酸（BA）升高。病情严重程度与孕产妇和新生儿并发症增加相关，最近的证据表明，当BA>100µmol/L时，围产期不良结局的风险显著升高，包括死产。 这项回顾性研究于2019年至2023年在一家三级围产医学中心进行，分两个阶段进行。在第一阶段，比较了ICP组和非ICP（对照组）的基线组特征和妊娠结局。在第二阶段，分析了三个ICP严重程度亚组的结局：轻度（BA<40µmol/L）、中度（BA 40-99µmol/L）和重度（BA≥100µmol/L）。 共有210例诊断为ICP的患者和24177例对照纳入分析。多变量回归后，结果表明，与轻度或中度疾病患者相比，重度ICP（BA≥100µmol/L）患者的围产期结局明显更差：26.7%的病例发生自发性早产（P=0.002），36.7%的病例发生医源性早产（P<0.001），43.3%的病例羊水粪染（P=0.001），23.3%的病例新生儿重症监护病房（NICU）入院（P=0.006）。该亚组的平均出生体重也最低（2830g，P<0.001）。值得注意的是，任何亚组均未记录到死产。与对照组相比，孕产妇特征没有明显差异，除了通过体外受精（IVF）受孕的妊娠（P=0.012）和并发妊娠期糖尿病的妊娠（P=0.040），两者发生ICP的风险均升高。 这项研究证实了ICP与围产期并发症增加之间的关联，疾病严重程度与较差的结局相关。研究结果强调了标准化BA检测的必要性以及改进围产期管理策略的必要性。
