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Intrahepatic Cholestasis of Pregnancy: An Intriguing Pregnancy-Specific Disorder

Laboratory of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Pontificia Universidad Católica de Chile, School of Medicine, and Department of Gastroenterology, Pontificia Universidad Católica de Chile, School of Medicine, Santiago, Chile; ICSM Maternal and Fetal Disease Group, MRC Clinical Sciences Center, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom agermain{at}med.puc.cl

Jorge A. Carvajal, MD, PhD

Juan Carlos Glasinovic, MD

Sumie Kato C., BS

Catherine Williamson, MD

Laboratory of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Pontificia Universidad Católica de Chile, School of Medicine, and Department of Gastroenterology, Pontificia Universidad Católica de Chile, School of Medicine, Santiago, Chile; ICSM Maternal and Fetal Disease Group, MRC Clinical Sciences Center, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom

Objective: To review animal and human data available regarding the etiology, maternal and fetal impact, and treatment of intrahepatic cholestasis of pregnancy (ICP).

Methods: Pertinent studies on human and animal models of ICP were selected through a MEDLINE database search, focusing on etiology and clinical impact of the disease. Analytic and descriptive studies were included, and the data were analyzed looking for crude numbers.

Results: Intrahepatic cholestasis of pregnancy is a pregnancy-specific disorder. Its prevalence is higher in Chile and Sweden compared with any other population. Its etiology is largely unknown, although endocrine, genetic, and environmental factors have been postulated as responsible for the appearance of the disease. Maternal effects of ICP are mild; however, there is a clear association between ICP and poor perinatal outcome, including a higher frequency of fetal distress, preterm labor and delivery, and unexplained fetal death. The treatment is mainly symptomatic. Recent data suggest that oral use of ursodeoxycholic acid improves maternal condition and might prevent the fetal complications of ICP.

Conclusions: Intrahepatic cholestasis of pregnancy should be considered a high-risk condition, and careful fetal assessment and appropriate medical intervention might improve perinatal outcome.

Key Words: Intrahepatic cholestasis of pregnancy • genetic basis of disease • preterm birth • fetal death

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