Bile acid levels increases the risk of poor outcomes of pregnancies with intrahepatic cholestasis of pregnancy (ICP)

Our researchers have looked at information from over 5,500 women with ICP and have found that the babies of women with extremely high bile acid levels are most at risk of stillbirth.

This study is now complete

Intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis, is a rare liver disorder that can develop during pregnancy. It affects around 1 in 140 pregnancies in the UK.

ICP happens when chemicals made by the liver – bile acids – leak into a woman’s bloodstream.The main symptom is itching, which is not harmful but can be very difficult to live with.

ICP can also increase the risks for the baby, with higher chances of premature birth and stillbirth.

No cure for ICP

There is no cure for ICP but ursodeoxycholic acid (UDCA) is often prescribed. This sometimes improves the itching and reduces bile acid levels, and researchers are working to find out whether it helps to protect the baby.

Women with ICP are monitored closely, and may need to be induced early if there is any concern about the wellbeing of their baby. However, babies that are born too soon sometimes need extra support – for example to help with their breathing – and so it is important that we understand more about which babies are most at risk of complications such as stillbirth.

Which babies are more at risk?

To find out more, we combined individual patient data and data from published studies to see whether the severity of ICP – determined by the amount of bile acids in blood – was linked to the likelihood of poor outcomes for the baby.

We analysed information from over 5,500 women with ICP and over 165,000 women with uncomplicated pregnancies.

ICP means higher likelihood of poor outcomes

We confirmed that the babies of women with ICP were more likely to have poor outcomes, including premature birth and breathing problems due to passing meconium (first poo) during pregnancy or labour, and were more likely to be admitted to a neonatal intensive care unit.

Women with extremely high levels of bile acids in their blood (³100 mmol/L) were much more likely to suffer a stillbirth than women with lower bile acid levels.

We will next use a similar approach to find out whether treatment with UDCA during pregnancy can lower the risk of poor outcomes, including stillbirth, for the babies of mothers with ICP.

 

The devastating effect of stillbirth

Stillbirth is devastating for families. We have been gathering testimony about the terrible effect of stillbirth on parents and wider family to raise awareness and make the case that more must be done to bring down the statistics.

'We sat on the bed laughing and joking, pushing the worry away. The midwife seemed to be away for ages. When she returned we were taken to a scan room to be scanned. As we walked in the room I knew something wasn’t right as there were three people in the room already. I nervously lay on the bed and after a few minutes the doctor turned to me and said, ‘I’m sorry but there’s no heartbeat.’

'Those words still make me feel sick to my stomach. I just remember screaming and screaming. I looked to David who sat with his head in his hands. I eventually managed to stop screaming and sat and cried uncontrollably. How could this have happened?'

Shelley, whose baby Joseph was stillborn at 37 weeks

Join the fight for healthy pregnancies and babies

Tommy's funds research across the UK investigating the reasons for miscarriage, stillbirth and premature birth, and fighting to make pregnancy and birth safer. We can keep you updated on ways you can support our work. If you would like to join our fight, click here.

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