Perinatal death by bile acid levels in intrahepatic cholestasis of pregnancy: a systematic review.
Publication/Presentation Date
11-1-2021
Abstract
BACKGROUND: Intrahepatic cholestasis of pregnancy (ICP) is characterized by the elevation of total bile acids (TBAs). The primary concern in women with ICP is the increased risk of stillbirth. ICP is generally considered as "mild" when TBA levels range from 10 to 39 µmol/L and "severe" with levels greater than 40 µmol/L, although levels of TBA ≥100 µmol/L have been also considered as a further threshold of severity.
OBJECTIVE: To quantify the association between different severities of ICP (TBA 10-39, 40-99, and ≥100 µmol/L) and perinatal death.
DATA SOURCES: Medline, Embase, Scopus, Web of Sciences, and ClinicalTrial.gov were searched from the inception of each database to February 2019.
METHODS OF STUDY SELECTION: Randomized, cohort, case-control, or case series studies reporting maternal and perinatal outcomes on women with ICP by the three prespecified TBA levels (10-39, 40-99, and ≥100 µmol/L) were included. We excluded multiple gestations and trials which included an intervention. The analysis was performed with Pearson chi-square and Fisher's exact test as appropriate. Continuous outcomes were compared using metaregression with inverse variance weighting using reported sample sizes and standard deviations. Pairwise comparisons used a Bonferroni correction to control for multiple testing.
TABULATION, INTEGRATION, AND RESULTS: Six articles including 1280 singleton pregnancies affected by ICP were included in the systematic review. Out of the 1280 singleton pregnancies affected by ICP included, 118 had ICP with TBA ≥100 µmol/L. Perinatal death was more common in women with TBA ≥100 µmol/L (0.4% for TBA 10-39 μmol/L
CONCLUSIONS: Maternal TBA ≥100 µmol/L is associated with a 6.8% incidence of perinatal death, most of which (5.9% overall) are stillbirths, while TBA < 100 µmol/L are associated with an incidence of perinatal death of 0.3%. It may be reasonable to consider late preterm delivery (at about 35-36 weeks) in women with TBA ≥100 µmol/L.
Volume
34
Issue
21
First Page
3614
Last Page
3622
ISSN
1476-4954
Published In/Presented At
Di Mascio, D., Quist-Nelson, J., Riegel, M., George, B., Saccone, G., Brun, R., Haslinger, C., Herrera, C., Kawakita, T., Lee, R. H., Benedetti Panici, P., & Berghella, V. (2021). Perinatal death by bile acid levels in intrahepatic cholestasis of pregnancy: a systematic review. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 34(21), 3614–3622. https://doi.org/10.1080/14767058.2019.1685965
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
31744346
Department(s)
Administration and Leadership
Document Type
Article