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Intrahepatic cholestasis of pregnancy as a risk factor for preeclampsia

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Intrahepatic cholestasis of pregnancy and preeclampsia are two major pregnancy complications. We aimed to investigate the association between intrahepatic cholestasis of pregnancy (ICP) and preeclampsia.

Methods

Single-center retrospective study. Study group included 180 women (162 singletons and 18 twin gestations) who were diagnosed with ICP based on clinical presentation, elevated liver enzymes and bile acids. The reference group included 1618 women (1507 singletons and 111 twin gestations) who delivered during the study period, and were matched according to age, gravidity, parity and singleton or twin gestation.

Results

The incidence of ICP was 0.36%. The incidence of preeclampsia was higher in women with ICP compared to reference group (7.78% vs 2.41%, aOR, 3.74 95% CI 12.0–7.02, p < 0.0001), for either without—(3.89% vs 1.61%, aOR 2.83, 95% CI 1.23–6.5, p = 0.145) or with severe features (3.89% vs 0.80%, aOR 5.17 95% CI 2.14–12.50, p = 0.0003). For both singleton and twin pregnancies, overall preeclampsia rates were higher in the ICP group (5.56% vs 2.19%, aOR 2.91 95% CI 1.39–6.07 p = 0.0045; and 27.78% vs 5.41%, aOR 10.9 95% CI 2.16–47.19, p = 0.0033, respectively). Earlier diagnosis of ICP was associated with higher incidence of preeclampsia (31.1 ± 3.8 vs 34.86 ± 6.2 gestational weeks, p = 0.0259). The average time between ICP diagnosis and to the onset of preeclampsia was 29.7 ± 24 days.

Conclusion

ICP is associated with an increased risk for preeclampsia. We suggest intensified follow-up for preeclampsia in women with ICP, especially among those with early ICP presentation and twins’ gestations.

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Author notes

  1. Nissim Arbib and Eran Hadar are equal contributors.

Authors and Affiliations

  1. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Matan Mor, Anat Shmueli, Eyal Krispin, Ron Bardin, Orly Sneh-Arbib, Marius Braun, Nissim Arbib & Eran Hadar

  2. Department of Obstetrics and Gynecology, Yitzhak Shamir Medical Center (Formerly Assaf Harofeh Medical Center), Zerifin, Israel

    Matan Mor

  3. Department of Obstetrics and Gynecology, Meir Medical Center, Kfar-Saba, Israel

    Nissim Arbib

  4. Rabin Medical Center, Helen Schneider Hospital for Women, 39 Jabotinsky Street, 4941492, Petach-Tikva, Israel

    Anat Shmueli, Eyal Krispin, Ron Bardin & Eran Hadar

  5. Rabin Medical Center, Liver Institute, Petach-Tikva, Israel

    Orly Sneh-Arbib & Marius Braun

Authors
  1. Matan Mor
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  2. Anat Shmueli
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  7. Nissim Arbib
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Contributions

MM: protocol/project development, data collection or management, data analysis, and manuscript writing/editing. AS: data collection or management, data analysis, and manuscript writing/editing. EK: data collection or management, data analysis, and manuscript writing/editing. RB: data collection or management, data analysis, and manuscript writing/editing. OS-A: data collection or management, data analysis, and manuscript writing/editing. MB: protocol/project development, data analysis, and manuscript writing/editing. NA: protocol/project development, data collection or management, data analysis, and manuscript writing/editing. EH: protocol/project development, data analysis, and manuscript writing/editing.

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Correspondence to Eran Hadar.

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Mor, M., Shmueli, A., Krispin, E. et al. Intrahepatic cholestasis of pregnancy as a risk factor for preeclampsia. Arch Gynecol Obstet 301, 655–664 (2020). https://doi.org/10.1007/s00404-020-05456-y

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  • DOI: https://doi.org/10.1007/s00404-020-05456-y

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