From the Guidelines
Prevalence of Jaundice in Pregnancy due to Cholestasis
The prevalence of jaundice in pregnancy due to cholestasis, specifically intrahepatic cholestasis of pregnancy (ICP), affects approximately 0.3% to 0.5% of pregnancies.
Key Factors Influencing Prevalence
- Geography and Ethnicity: The prevalence varies significantly by geography and ethnicity, with higher rates reported in South America, particularly in Chile, and in Sweden and Baltic countries 1.
- Genetic and Hormonal Factors: Genetic, hormonal (estrogen and sulphated progesterone), and environmental factors have been linked with the risk of developing ICP 1.
- Maternal Factors: Advanced maternal age, multiparity, metabolic syndrome, and HCV infection are also associated with an increased risk of ICP 1.
Clinical Presentation and Diagnosis
- Symptoms: The classic symptom of ICP is generalized pruritus, most severe in the palms and soles without an accompanying rash, typically onset in the second or third trimester 1.
- Laboratory Tests: Elevated serum bile acid levels and AST and ALT levels are common in ICP, with total bile acids >100 μmol/L indicating severe ICP 1.
Fetal Risks
- Preterm Delivery and Stillbirth: ICP confers risks to the fetus, including preterm delivery, meconium-stained amniotic fluid, and stillbirth, with the prevalence of intrauterine fetal demise (IUFD) increasing with higher serum total bile acid levels 1.
From the Research
Prevalence of Jaundice in Pregnancy due to Cholestasis
- The prevalence of intrahepatic cholestasis of pregnancy (ICP) varies by region, with higher incidence in South American and Scandinavian countries (9.2%-15.6% and 1.5%, respectively) compared to Europe (0.1%-0.2%) 2.
- ICP is a rare disorder, predominantly occurring during the third trimester of pregnancy, characterized by pruritus, jaundice, and biochemical disturbances in liver enzymes 3.
- Jaundice is a common symptom of ICP, occurring in some cases, and is often accompanied by pruritus and elevated serum bile acids concentrations 4, 5.
- The exact prevalence of jaundice in pregnancy due to cholestasis is not specified in the studies, but it is estimated that ICP accounts for 20% of cases of jaundice occurring in pregnancy 5.
Characteristics of Intrahepatic Cholestasis of Pregnancy
- ICP is characterized by pruritus, elevated liver enzymes, and increased serum bile acids, typically appearing in the late second or third trimester and resolving after delivery 2, 3, 6.
- The etiology of ICP is multifactorial, involving genetic, endocrine, and environmental factors 2.
- Maternal outcome is usually benign, but fetal complications such as preterm labor, meconium staining, fetal distress, and sudden intrauterine fetal demise can occur 2, 3, 6.
Diagnosis and Management of Intrahepatic Cholestasis of Pregnancy
- Diagnosis of ICP involves careful monitoring of maternal hepatic function tests and serum bile acid levels, as well as assessment of fetal well-being 2, 6.
- Treatment with ursodeoxycholic acid is suggested, coupled with close maternal-fetal surveillance and delivery as close to term as possible 2, 3, 5.