Intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a cholestatic
disorder characterized by (i) pruritus with onset in the second or
third trimester of pregnancy, (ii) elevated serum aminotransferases
and bile acid levels, and (iii) spontaneous relief of signs and
symptoms within two to three weeks after delivery. ICP is observed
in 0.4-1% of pregnancies in most areas of Central and Western
Europe and North America, while in Chile and Bolivia as well as
Scandinavia and the Baltic states roughly 5-15% and 1-2%,
respectively, of pregnancies are associated with ICP. Genetic and
hormonal factors, but also environmental factors may contribute to
the pathogenesis of ICP. Intrahepatic cholestasis of pregnancy
increases the risk of preterm delivery (19-60%), meconium staining
of amniotic fluid (27%), fetal bradycardia (14%), fetal distress
(22-41%), and fetal loss (0.4-4.1%), particularly when associated
with fasting serum bile acid levels > 40 mu mol/L. The
hydrophilic bile acid ursodeoxycholic acid (10-20 mg/kg/d) is today
regarded as the first line treatment for intrahepatic cholestasis
of pregnancy. Delivery has been recommended in the 38(th) week when
lung maturity has been established.