17 research outputs found
Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers
__Background__ Intrahepatic cholestasis of pregnancy is associated with adverse perinatal outcomes, but the association
with the concentration of specific biochemical markers is unclear. We aimed to quantify the adverse perinatal effects
of intrahepatic cholestasis of pregnancy in women with increased serum bile acid concentrations and determine
whether elevated bile acid concentrations were associated with the risk of stillbirth and preterm birth.
__Methods__ We did a systematic review by searching PubMed, Web of Science, and Embase databases for studies
published from database inception to June 1, 2018, reporting perinatal outcomes for women with intrahepatic
cholestasis of pregnancy when serum bile acid concentrations were available. Inclusion criteria were studies defining
intrahepatic cholestasis of pregnancy based upon pruritus and elevated serum bile acid concentrations, with or
without raised liver aminotransferase concentrations. Eligible studies were case-control, cohort, and populationbased studies, and randomised controlled trials, with at least 30 participants, and that reported bile acid concentrations
and perinatal outcomes. Studies at potential higher risk of reporter bias were excluded, including case reports, studies
not comprising cohorts, or successive cases seen in a unit; we also excluded studies with high risk of bias from
groups selected (eg, a subgroup of babies with poor outcomes were explicitly excluded), conference abstracts, and
Letters to the Editor without clear peer review. We also included unpublished data from two UK hospitals. We did a
random effects meta-analysis to determine risk of adverse perinatal outcomes. Aggregate data for maternal and
perinatal outcomes were extracted from case-control studies, and individual patient data (IPD) were requested from
study authors for all types of study (as no control group was required for the IPD analysis) to assess associations
between biochemical markers and adverse outcomes using logistic and stepwise logistic regression. This study is
registered with PROSPERO, number CRD42017069134.
__Findings__ We assessed 109 full-text articles, of which 23 studies were eligible for the aggregate data meta-analysis
(5557 intrahepatic cholestasis of pregnancy cases and 165136 controls), and 27 provided IPD (5269 intrahepatic
cholestasis of pregnancy cases). Stillbirth occurred in 45 (0·91%) of 4936 intrahepatic cholestasis of pregnancy cases
and 519 (0·32%) of 163947 control pregnancies (odds ratio [OR] 1·46 [95% CI 0·73–2·89]