Abstract：
OBJECTIVE: Intrahepatic cholestasis of pregnancy (ICP) is associated with an increased risk of adverse perinatal outcomes, resulting in a higher risk of perinatal morbidity and mortality.
METHODS: The authors conducted a retrospective study of 2385 singletons with ICP who underwent risk-stratified management strategies. To explore the risks of perinatal outcomes of ICP, subgroup analyses were performed using different total bile acid (TBA) levels.
RESULTS: In this study, there was only one stillbirth and one neonatal death. Among the study cohort, 2299 patients had ICP with a TBA level ≥10 μmol/L and 86 had ICP with a TBA level <10 μmol/L. The 2299 patients with ICP (TBA level ≥ 10 μmol/L) were divided into three groups: mild ICP (n = 1803), severe ICP (n = 400), and extremely severe ICP (n = 96). Increased TBA concentration was associated with an increased incidence of preterm birth, newborn asphyxia, neonatal intensive care unit hospitalization, meconium-stained amniotic fluid, and low birth weight in the three groups (P < 0.05). Furthermore, severe and extremely severe ICP with hypotonic absonant uterine contraction had a significant effect on neonatal asphyxia (odds ratio, 5.06 [95% confidence interval, 1.09-23.37]; P < 0.05) and meconium-stained amniotic fluid (odds ratio, 2.37 [95% confidence interval, 1.43-3.93]; P < 0.05).
CONCLUSIONS: Hypotonic absonant uterine contractions could be high-risk stressors for severe and extremely severe ICP; hence, proper prenatal care is recommended. Risk-stratified management strategies for ICP are critical to obtaining better maternal-fetal outcomes.
METHODS: The authors conducted a retrospective study of 2385 singletons with ICP who underwent risk-stratified management strategies. To explore the risks of perinatal outcomes of ICP, subgroup analyses were performed using different total bile acid (TBA) levels.
RESULTS: In this study, there was only one stillbirth and one neonatal death. Among the study cohort, 2299 patients had ICP with a TBA level ≥10 μmol/L and 86 had ICP with a TBA level <10 μmol/L. The 2299 patients with ICP (TBA level ≥ 10 μmol/L) were divided into three groups: mild ICP (n = 1803), severe ICP (n = 400), and extremely severe ICP (n = 96). Increased TBA concentration was associated with an increased incidence of preterm birth, newborn asphyxia, neonatal intensive care unit hospitalization, meconium-stained amniotic fluid, and low birth weight in the three groups (P < 0.05). Furthermore, severe and extremely severe ICP with hypotonic absonant uterine contraction had a significant effect on neonatal asphyxia (odds ratio, 5.06 [95% confidence interval, 1.09-23.37]; P < 0.05) and meconium-stained amniotic fluid (odds ratio, 2.37 [95% confidence interval, 1.43-3.93]; P < 0.05).
CONCLUSIONS: Hypotonic absonant uterine contractions could be high-risk stressors for severe and extremely severe ICP; hence, proper prenatal care is recommended. Risk-stratified management strategies for ICP are critical to obtaining better maternal-fetal outcomes.
摘要：
目的：妊娠期肝内胆汁淤积症（ICP）与不良围产期结局的风险增加有关，导致更高的围产期发病率和死亡率的风险。
方法：作者对2385例接受风险分层管理策略的ICP患者进行了回顾性研究。探讨ICP围产期结局的风险,使用不同的总胆汁酸(TBA)水平进行亚组分析.
结果：在这项研究中，只有一例死产和一例新生儿死亡。在研究队列中，2299例患者ICP的TBA水平≥10μmol/L，86例患者ICP的TBA水平<10μmol/L。将2299例ICP(TBA水平≥10μmol/L)患者分为3组:轻度ICP(n=1803),重度ICP（n=400），和极其严重的ICP（n=96）。TBA浓度增加与早产发生率增加有关，新生儿窒息,新生儿重症监护病房住院,羊水胎粪污染,3组新生儿低出生体重(P<0.05)。此外，重度和极重度ICP伴低张性子宫收缩对新生儿窒息有显著影响(比值比，5.06[95%置信区间，1.09-23.37]；P<0.05）和胎粪染色的羊水（比值比，2.37[95%置信区间，1.43-3.93]；P<0.05）。
结论：低张性子宫收缩可能是严重和极严重ICP的高风险应激源；因此，建议进行适当的产前护理。ICP的风险分层管理策略对于获得更好的母婴结局至关重要。
方法：作者对2385例接受风险分层管理策略的ICP患者进行了回顾性研究。探讨ICP围产期结局的风险,使用不同的总胆汁酸(TBA)水平进行亚组分析.
结果：在这项研究中，只有一例死产和一例新生儿死亡。在研究队列中，2299例患者ICP的TBA水平≥10μmol/L，86例患者ICP的TBA水平<10μmol/L。将2299例ICP(TBA水平≥10μmol/L)患者分为3组:轻度ICP(n=1803),重度ICP（n=400），和极其严重的ICP（n=96）。TBA浓度增加与早产发生率增加有关，新生儿窒息,新生儿重症监护病房住院,羊水胎粪污染,3组新生儿低出生体重(P<0.05)。此外，重度和极重度ICP伴低张性子宫收缩对新生儿窒息有显著影响(比值比，5.06[95%置信区间，1.09-23.37]；P<0.05）和胎粪染色的羊水（比值比，2.37[95%置信区间，1.43-3.93]；P<0.05）。
结论：低张性子宫收缩可能是严重和极严重ICP的高风险应激源；因此，建议进行适当的产前护理。ICP的风险分层管理策略对于获得更好的母婴结局至关重要。
