Materiały źródłowe

• #1 Pregnancy Intrahepatic Cholestasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK551503/

  Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disease related to pregnancy. The Incidence and prevalence of ICP vary with ethnicity and geographic distribution. ICP incidence rate is between 0.2 to 2% of pregnancies. It is more common in South American and northern European continents. Research has described ICP in 0.2 to 0.3% of pregnancies in the USA. A higher incidence of ICP is observable with a prior history of ICP, chronic liver disease, chronic hepatitis C, multifetal pregnancy, and advanced maternal age. The recurrence rate of ICP in subsequent pregnancies is high (60 to 70 percent). Turunen K et al. did a survey of 544 former ICP patients and 1235 controls which showed 12.8% of mothers (odds ratio 9.2), 15.9% of sisters (odds ratio 5.3), and 10.3% of daughters (odds ratio 4.8) of women with a history of ICP had liver dysfunction during pregnancy. Similarly, estimates for the relative risk for the siblings of affected women were 12% in another study.

• #2 Intrahepatic cholestasis of pregnancy – UpToDate

  https://www.uptodate.com/contents/intrahepatic-cholestasis-of-pregnancy

  Intrahepatic cholestasis of pregnancy (ICP) is characterized by pruritus and an elevation in serum bile acid concentrations, typically developing in the late second and/or third trimester and rapidly resolving after delivery. […] ICP is the most common liver disease unique to pregnancy. The incidence varies from <1 to 27.6 percent worldwide. In the United States, the incidence is 0.8 percent but ranged from 0.32 percent in Bridgeport Hospital, Connecticut to 5.6 percent in a primarily Hispanic population in Los Angeles. Across Europe, the incidence ranges from 0.5 to 1.5 percent, with the highest rates in Scandinavia. In Indian Asian and Pakistani Asian populations, the incidence is 1.2 to 1.5 percent. The Araucanos Indians in Chile have the highest incidence worldwide at 27.6 percent. The reason for the wide variation in incidence is incompletely understood. Geographic variations may reflect differences in susceptibility between ethnic groups and differences in environmental factors.

• #3 Global and regional incidence of intrahepatic cholestasis of pregnancy: a systematic review and meta-analysis | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-025-03935-0

  Intrahepatic cholestasis of pregnancy (ICP) can be a source of significant distress for both pregnant women and the fetus, impairing the quality of life and well-being of pregnant women, leading to psychological disorders among pregnant women with severe or recurrent ICP, and causing life-threatening complications among fetuses. […] Regrettably, our current understanding of ICP globally is limited, lacking a comprehensive estimation of its incidence. […] A total of 42,972,872 pregnant women were analyzed from 302 studies. The overall pooled incidence [95% confidence interval] of ICP was 2.9% [2.5, 3.3]. […] Studies with larger sample sizes tended to provide significantly lower estimates of ICP incidence: 1.6% [1.3, 2] vs 4.7% [3.9, 5.5]. […] Asia had the highest incidence of ICP among the continents, whereas Oceania had the lowest.

• #4 Intrahepatic Cholestasis of Pregnancy: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/1562288-overview

  The incidence of ICP varies greatly not only throughout the world, but throughout different regions in the United States as well. Evidence of family clustering and prevalence in certain ethnic groups may partially explain the geographic variation in incidence. For example, the Chilean population overall has a 16% incidence of ICP, and a subpopulation in Chile, the Araucanos Indians, has an incidence of 28%. […] Although ICP is more common in South Asia, South America, and the Scandinavian countries, the incidence in the United States varies greatly. The United States has a heterogeneous population, and thus the incidence has a wide range, 0.32-5.6%. […] ICP also shows seasonal variation, occurring more frequently in the winter months. […] Other risk factors for ICP include advanced maternal age, a personal or family history of cholestasis with oral contraceptive use, and multiparity.

• #5 Intrahepatic cholestasis of pregnancy | Orphanet Journal of Rare Diseases | Full Text

  https://ojrd.biomedcentral.com/articles/10.1186/1750-1172-2-26

  Intrahepatic cholestasis of pregnancy (ICP) is observed in 0.41% 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. […] The incidence of ICP was highest in Bolivia and Chile several decades ago (up to 14% of all pregnancies before 1975), particularly among the Araucanos Indians of Chile (27.6%) and the Aimara Indians of Bolivia (13.8%), but has considerably decreased in these countries more recently to less than 2% of all births today. […] In Scandinavian and Baltic countries, ICP occurs in up to 2% of all pregnancies, while in other regions of Europe, Asia, North America and Australia the reported incidence is less than 1%. […] While the incidence has recently decreased in the high-incidence regions, it increased in low-incidence areas, possibly reflecting the raising awareness of the disease. […] ICP is more common in the winter months in Chile and Scandinavia, and in twin and multiple pregnancies.

• #6 Intrahepatic cholestasis of pregnancy: A past and present riddle | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-intrahepatic-cholestasis-pregnancy-a-past-S1665268119320125

  Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific disorders that occurs mainly in the third trimester of pregnancy and is characterized by pruritus and elevated bile acid levels. ICP has been diagnosed in almost all ethnic groups. The prevalence of this disease ranges from 1 case out of 1,000 to 1 case out of 10,000 deliveries in North America, Asia, and Australia. An intriguing higher prevalence (10 to 100-fold) has been reported between 1950 and 1980 in Chile (particularly in the native southern [Mapuche] population) and in Sweden and other Scandinavian countries. Reported figures reached up to 14% of pregnant women in Chile. Interestingly, in the following years the prevalence of the disease has markedly decreased in both regions. The estimated current prevalence in Chile ranges from 1.5 to 4% of all pregnancies. Advanced maternal age and multiple gestations are associated to an increased incidence of ICP. The disease may also cluster in families with around 16% of cases being familial. The reported recurrence rate of ICP varies between 40 and 60% of pregnancies with a great variations in the intensity of the disease in subsequent pregnancies and in a random fashion.

• #7 Intrahepatic cholestasis of pregnancy | RCOG

  https://www.rcog.org.uk/for-the-public/browse-our-patient-information/intrahepatic-cholestasis-of-pregnancy/

  ICP is uncommon. In the UK, it affects about 7 in 1000 women (less than 1%). It is more common among women of Indian-Asian or Pakistani-Asian origin, with up to 15 in 1000 women (1.5%) affected. […] Your chance of having a stillbirth depends on the level of bile acids found in your blood as well as any other pregnancy complications you may be experiencing. […] If your bile acid levels are 100 micromol/L or more (Severe ICP), your chance of having a stillbirth is higher than someone who doesn’t have ICP and is around 3%. Most of these stillbirths happen after 36 weeks of pregnancy.

• #8 Surveillance of severe obstetric cholestasis | NPEU

  https://www.npeu.ox.ac.uk/research/projects/74-ukoss-cholestasis

  Previous retrospective case series have suggested that intrahepatic cholestasis of pregnancy (ICP) is associated with adverse fetal outcomes, but there have been concerns over possible biases in these studies. […] 713 confirmed cases of severe ICP were identified, giving an estimated incidence of 9.2 cases per 10,000 maternities. […] Women with a singleton pregnancy affected by severe ICP (n=669) had increased odds of preterm delivery (adjusted odds ratio (aOR) 5.39, 95% CI 4.17 to 6.98), neonatal unit admission (aOR 2.68, 95% CI 1.97 to 3.65) and stillbirth (aOR 2.58, 95% CI 1.03 to 6.49) compared to control women, and these risks rose with increasing maternal serum bile acid concentrations. […] The risks of preterm delivery (both spontaneous and iatrogenic) and stillbirth were also raised when compared with national data. […] These findings support the case for close antenatal monitoring of pregnancies affected by severe ICP.

• #9 Intrahepatic cholestasis of pregnancy – UpToDate

  https://www.uptodate.com/contents/intrahepatic-cholestasis-of-pregnancy

  For unknown reasons, the disease occurs more commonly in the winter months in some countries (eg, Sweden, Finland, Chile). A past history of ICP is a strong risk factor for recurrence in subsequent pregnancies. Other risk factors include multiple gestation, chronic hepatitis C virus infection, personal or family history of intrahepatic cholestasis, and advanced maternal age.

• #10 Intrahepatic Cholestasis of Pregnancy: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/1562288-overview

  In addition, women with twin pregnancies are 5 times more likely to develop ICP than women with a singleton pregnancy. […] Some investigators have noted the association of hepatitis C with ICP. They observed that patients with hepatitis C have an increased risk for ICP, and likewise women with ICP are at increased risk for acquiring hepatitis C. These researchers recommend testing for hepatitis C in this population. […] In terms of risk of severe disease, Mashburn et al noted increased severity in patients with pregestational diabetes mellitus (DM), prior cholecystectomy, and tobacco use.

• #11 Cholestasis of pregnancy – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cholestasis-of-pregnancy/symptoms-causes/syc-20363257

  Intrahepatic cholestasis of pregnancy, commonly known as cholestasis of pregnancy, is a liver condition that can occur in late pregnancy. […] Cholestasis of pregnancy can make you very uncomfortable. But more worrisome are the potential complications, especially for your baby. Because of the risk of complications, your pregnancy care provider may recommend early term delivery around 37 weeks. […] If you have a history of cholestasis in a prior pregnancy, your risk of developing it during another pregnancy is high. About 60% to 70% of females have it happen again. This is called a recurrence. In severe cases, the risk of recurrence may be as high as 90%. […] Complications from cholestasis of pregnancy appear to be due to high bile acid levels in the blood. Complications may occur in the mom, but the developing baby is especially at risk. […] Because complications can be very dangerous for your baby, your pregnancy care provider may consider inducing labor before your due date.

• #12 Global and regional incidence of intrahepatic cholestasis of pregnancy: a systematic review and meta-analysis | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-025-03935-0

  Countries that were classified as developed and with higher income had a lower incidence of ICP than those classified as developing and low and middle income. […] The findings of this study will provide valuable insights into the current knowledge regarding the association of the quality of public health and socioeconomic variations with the incidence of ICP on a global scale. […] The global pooled incidence of ICP and its 95% confidence interval (CI) was 2.9% [2.5, 3.3] from all the studies and 1.5% from non-outlier studies with larger-than-median sample sizes. […] The subgroup analyses showed that South-East Asian Region (SEAR) had the highest incidence of ICP 4.7% [2.9%, 6.9%] while the incidence was the lowest in the Eastern Mediterranean Region (EMR) 1.6% [1.1%, 2.3%] among the WHO regional classes.

• #13 Intrahepatic Cholestasis in Pregnancy: Review of the Literature

  https://www.mdpi.com/2077-0383/9/5/1361

  Intrahepatic cholestasis of pregnancies is one of the most common liver diseases closely related to pregnancy. The disease resolves spontaneously after delivery; however, it tends to recur in a more severe form in 45–90% of subsequent pregnancies. ICP rates are different in different ethnic groups depending on the geographical region. In the Polish population, the estimated incidence rate is in the range of 1–4%. A much higher rate of up to 25% is observed among Andean Natives. In Europe, North America and Australia, ICP is encountered in about 1–2% of pregnant women. The morbidity rate increases with age and the multiplicity of pregnancy. […] The etiology of ICP is not fully explained, with attention being drawn to the contribution from genetic, hormonal, and environmental factors. Among the genetic factors, mutations of the hepatobiliary transport protein-multidrug resistance protein 3 (MDR3) involved in the biliary secretion of phospholipids, are assigned a major role in the pathogenesis of ICP. MDR3 mutations are observed in approximately 16% of all ICP cases; their presence is also related to the severity of the disease and TBA levels of above 40 μmol/L. However, MDR3 protein-coding disorders may occur not only in ICP but also in hereditary low phospholipid-associated cholelithiasis (LPA), as well as in drug-induced cholestasis.

• #14 Intrahepatic cholestasis of pregnancy : genetic background, epidemiology and hepatobiliary consequences

  https://helda.helsinki.fi/items/3e7e8dc7-96e1-4eb1-b0d5-68390dca86b0

  Intrahepatic cholestasis of pregnancy (ICP) is the most common cholestatic liver disease during pregnancy. The reported incidence varies from 0.4 to 15% of full-term pregnancies. […] In a register-based nation-wide study (n=1 080 310) the incidence of ICP was 0.94% during 1987-2004. A slightly higher incidence, 1.3%, was found in a hospital-based series (n=5304) among women attending the University Hospital of Helsinki in 1992-1993. […] In the register-based epidemiological study, advanced maternal age and, to a lesser degree, parity were identified as new risk factors for ICP. The risk was 3-fold higher in women >39 years of age compared to women <30 years. Multiple pregnancy also associated with an elevated risk. [...] In conclusion, ICP complicates around 1% of all full-term pregnancies in Finland and its incidence has remained unchanged since 1987. It is familial in 16% of cases with a higher recurrence rate. Although the cause remains unknown, several risk factors, namely advanced maternal age, parity and multiple pregnancies, can be identified.

• #15 Prevalence and risk factors of intrahepatic cholestasis of pregnancy in a Chinese population | Scientific Reports

  https://www.nature.com/articles/s41598-020-73378-5

  Studies on the risk factors for intrahepatic cholestasis of pregnancy (ICP) in a population-based cohort are lacking. We assess the prevalence and risk factors of ICP in a Chinese population. In this study, a cohort study was conducted that included 12,200 eligible pregnant women. The overall incidence of ICP in this cohort was 6.06%. […] Maternal age (25 or 35 years), underweight, inadequate GWG, lower maternal education, multiparity, and twin/multiple pregnancies were identified as risk factors of ICP. […] The objective of the current study was to assess the prevalence and risk factors of ICP in a Chinese population. We found that pregnancy at a young or advanced maternal age, underweight, inadequate GWG, lower maternal education, multiparity, and twins/multiple pregnancies were associated with an increased risk of ICP.

• #16 Intrahepatic Cholestasis in Pregnancy: Increased Surveillance and the Role of Bile Acids in a Patient with History of Fetal Demise

  https://clinmedjournals.org/articles/ogcr/obstetrics-and-gynaecology-cases-reviews-ogcr-8-212.php?jid=ogcr

  Intrahepatic cholestasis of pregnancy (ICP) is a known risk for fetal demise and premature delivery. […] The risk is higher for Latin females who have an incidence of up to 15% versus the general obstetric population 0.3-0.5%. […] During pregnancy, serum bile acids within the fetus are slightly higher than those in the maternal circulation where they are ultimately transferred for excretion. […] In ICP, the fetomaternal concentration gradient is reversed and is known to increase risk of fetal complications such as stillbirth, spontaneous preterm birth, and vasospasms leading to abnormal ECG findings. […] The use of ursodeoxycholic acid (UDCA) has demonstrated efficacy in the treatment of symptomatic ICP cases and, reducing the likelihood of neonatal cardiac abnormalities. […] Obstetricians are in a position to survey risk factors unique to their patients such as those who have had a cholestatic response to oral contraceptives and have the benefit of more frequent visits. […] More frequent monitoring could relieve these symptoms and support the need for increased surveillance.

• #17 Society for Maternal-Fetal Medicine Consult Series #53: Intrahepatic cholestasis of pregnancy – SMFM Publications and Clinical Guidelines

  https://publications.smfm.org/publications/374-society-for-maternal-fetal-medicine-consult-series-53/

  Intrahepatic cholestasis of pregnancy is a hepatic disorder characterized by pruritus and an elevation in serum bile acid levels. […] Although intrahepatic cholestasis of pregnancy poses little risk for women, this condition carries a significant risk for the fetus, including complications such as preterm delivery, meconium-stained amniotic fluid, and stillbirth. […] The recommendations by the Society for Maternal-Fetal Medicine are as follows: (1) we recommend measurement of serum bile acid and liver transaminase levels in patients with suspected intrahepatic cholestasis of pregnancy (GRADE 1B); (2) we recommend that ursodeoxycholic acid be used as the first-line agent for the treatment of maternal symptoms of intrahepatic cholestasis of pregnancy (GRADE 1A); (3) we suggest that patients with a diagnosis of intrahepatic cholestasis of pregnancy begin antenatal fetal surveillance at a gestational age when delivery would be performed in response to abnormal fetal testing results or at the time of diagnosis if the diagnosis is made later in gestation (GRADE 2C); (4) we recommend that patients with total bile acid levels of 100 mol/L be offered delivery at 36 0/7 weeks of gestation, given that the risk of stillbirth increases substantially around this gestational age (GRADE 1B); (5) we recommend delivery between 36 0/7 and 39 0/7 weeks of gestation for patients with intrahepatic cholestasis of pregnancy and total bile acid levels of 100 mol/L (GRADE 1C); (6) we recommend administration of antenatal corticosteroids for fetal lung maturity for patients delivering before 37 0/7 weeks of gestation if not previously administered (GRADE 1A); (7) we recommend against preterm delivery at 37 weeks of gestation in patients with a clinical diagnosis of intrahepatic cholestasis of pregnancy without laboratory confirmation of elevated bile acid levels (GRADE 1B).

• #18 Severe Obstetric Cholestasis | UKOSS | NPEU

  https://www.npeu.ox.ac.uk/ukoss/completed-surveillance/oc

  Severe obstetric cholestasis is associated with an increased risk of adverse fetal outcomes. […] The risk of adverse fetal outcomes is thought to be increased in women with severe obstetric cholestasis. […] There are no prospective national studies to estimate the incidence or outcomes of severe obstetric cholestasis in pregnancy. […] This study will investigate the incidence, management and outcomes for mother and infant in pregnancies where the mother has severe obstetric cholestasis. […] Severe obstetric cholestasis (OC), also called intrahepatic cholestasis of pregnancy, is a pregnancy specific liver disorder that affects about 1 in 200 women in the UK. […] The aetiologies of the maternal disease and the fetal complications associated with the condition are not completely understood.

• #19 Asymptomatic intrahepatic cholestasis of pregnancy

  https://www.oatext.com/asymptomatic-intrahepatic-cholestasis-of-pregnancy.php

  Pruritus is a varying symptom of cholestatic liver diseases. Previous studies suggested that latent intrahepatic cholestasis of pregnancy (ICP) affects a subset of pregnant women. The aim of this study was to assess the characteristics of asymptomatic ICP and its course following treatment. […] Intrahepatic cholestasis of pregnancy (ICP) is one of the most common liver diseases associated with pregnancy. The prevalence varies in different geographic regions and ethnic groups, but the average ranges from 1.5% to 2%. ICP is due to the abnormal transport of bile from the hepatocytes to bile canaliculi and develops in predisposed women, mainly in the second half of pregnancy, due to high sex hormone levels. The disease is benign and resolves spontaneously after delivery. However, ICP can cause multiple fetal complications during the perinatal period.

• #20 Asymptomatic intrahepatic cholestasis of pregnancy

  https://www.oatext.com/asymptomatic-intrahepatic-cholestasis-of-pregnancy.php

  The lack of significant differences in clinical pattern, pregnancy outcome, and laboratory signs of liver damage suggests that asymptomatic ICP is not associated with pruritus. Since asymptomatic ICP and classical ICP carry the same risk to the fetus, it seems appropriate to perform BAs laboratory screening in pregnant women to detect subclinical ICP. […] The lack of significant differences in pregnancy complication rates and baseline biochemical measurements in pregnant women with ICP with or without pruritus suggests that asymptomatic ICP is a distinct subclinical variant of ICP. […] Due to the subclinical latent course, the diagnosis of asymptomatic ICP which carries a high risk of pregnancy complications may be missed. In our study, screening of pregnant women with or without pruritus revealed a high prevalence of asymptomatic ICP that may be similar to the prevalence of classical ICP. Therefore, the determination BAs serum levels may be appropriate not only in patients with clinical symptoms of ICP, but also in patients without pruritus who have increased levels of transaminases or cholestatic liver enzymes or a family history of ICP.

• #21 Intrahepatic Cholestasis of Pregnancy

  https://www.exxcellence.org/list-of-pearls/intrahepatic-cholestasis-of-pregnancy/?categoryName=&searchTerms=%2C&featured=False&bookmarked=False&sortColumn=date%2C&sortDirection=Descending

  Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy-specific liver disease. While the incidence of ICP varies greatly among ethnic groups, in the United States incidence ranges from 0.32% in predominantly White populations to 5.6% in predominantly Latina populations. […] ICP is associated with preterm delivery, non-reassuring fetal status, meconium-staining, respiratory distress syndrome, and stillbirth, with a linear relationship between serum bile acid levels and the risk of fetal complications. […] Measurement of serum bile acid and liver transaminase levels in patients with suspected ICP is recommended. Antenatal fetal surveillance is recommended at a gestational age when delivery would be performed in response to abnormal fetal testing results or at the time of diagnosis if the diagnosis is made later in gestation, although fetal benefit has yet to be demonstrated. […] Both ACOG and SMFM recommend that patients with total bile acid levels of 100 mmol/L be offered delivery at 36 0/7 weeks of gestation, and between 36 0/7 and 39 0/7 weeks of gestation for patients with ICP and total bile acid levels of 100 mmol/L.

• #22

  https://journals.lww.com/jsci/fulltext/2020/47010/impact_of_obstetric_cholestasis_on_fetal_outcome__.7.aspx

  Intrahepatic cholestasis of pregnancy (ICP) or obstetric cholestasis (OC), while classified as a pregnancy dermatosis, is in fact the most common liver disease of pregnancy associated with significant fetal mortality and morbidity, as well as lifelong health risks for the offspring. […] Older studies using biochemical abnormalities to diagnose OC have reported a perinatal mortality rate of 10%15%. This has been reduced to 3.5% or less in more recent studies using policies of active management. […] ICP is relatively benign to women, but it has been reported to have important fetal implications with increased risk of respiratory distress, preterm delivery, low birth weight, meconium staining of amniotic fluid, fetal bradycardia, fetal distress, and fetal demise. […] The perinatal mortality in OC has been reduced to 3.5% or less in more recent studies using policies of active management.

• #23 Intrahepatic cholestasis of pregnancy – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/800

  Intrahepatic cholestasis of pregnancy (ICP) is characterized by maternal pruritus (itch) and liver dysfunction, with raised total serum bile acid concentrations, in the absence of other contributing liver disorders and restricted to pregnancy. […] The condition is associated with an increased risk of adverse pregnancy outcomes for the newborn, including spontaneous preterm birth, meconium-stained amniotic fluid, neonatal unit admission, and, if the mothers serum bile acid concentrations are elevated to a level of 100 micromol/L, stillbirth. Maternal complications include an increased risk of gestational diabetes and preeclampsia, in addition to impaired glucose tolerance and dyslipidemia. […] Maternal complications include an increased risk of gestational diabetes and preeclampsia, in addition to impaired glucose tolerance and dyslipidemia; fetal complications include preterm birth, meconium-staining of the amniotic fluid, neonatal unit admission, and, in pregnant women with bile acid concentrations of 100 micromol/L, intrauterine fetal death (stillbirth).

• #24 Intrahepatic Cholestasis of Pregnancy

  https://liverfoundation.org/liver-diseases/complications-of-liver-disease/intrahepatic-cholestasis-of-pregnancy-icp/

  Intrahepatic Cholestasis of Pregnancy (ICP) is a liver disorder which occurs during pregnancy. […] Cholestasis occurs in about 1 out of 1,000 pregnancies but is more common in Swedish and Chilean ethnic groups. […] Overall, 1 to 2 pregnancies in 1,000 is affected by ICP in the USA with Latina populations at 5.6%. […] The incidence of ICP also shows a striking geographical pattern, with a higher prevalence in Scandinavia and South America specifically Chile where the reported prevalence is as high as 15.6%. […] A recent meta-analysis was able to further clarify the risk of stillbirth in a pregnancy complicated by cholestasis and showed that this risk increases as bile acids become more elevated. […] With bile acids remaining under 100 mol/L, the risk is less than 0.28% and similar to a normal pregnancy. When bile acid levels are over 100, the risk of stillbirth increases to over 3%. […] Despite the possible outcomes of ICP, proper treatment provides a great degree of reduction in both fetal risk and maternal symptoms.

• #25 Maternal intrahepatic cholestasis of pregnancy and neurodevelopmental conditions in offspring: A population-based cohort study of 2 million Swedish children | PLOS Medicine

  https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004331

  Maternal intrahepatic cholestasis of pregnancy (ICP) is the most common obstetric liver disorder and is associated with an increased risk of iatrogenic preterm birth and adverse infant outcomes. […] In this study, we observed that exposure to ICP during gestation is associated with an increased likelihood of neurodevelopmental conditions in offspring, particularly in cases of early-onset ICP. […] Intrahepatic cholestasis of pregnancy (ICP) is the most common obstetric liver disorder, affecting 0.5% to 2% of pregnant women. […] Despite some of these factors, such as preterm birth, being associated with adverse neonatal outcomes, including neurodevelopmental conditions, to the best of our knowledge, there have been no previous studies examining neurodevelopmental conditions among offspring exposed to ICP during pregnancy.

• #26 Maternal intrahepatic cholestasis of pregnancy and neurodevelopmental conditions in offspring: A population-based cohort study of 2 million Swedish children | PLOS Medicine

  https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004331

  The strength of the association between ICP and offspring neurodevelopmental conditions increased the earlier ICP was diagnosed. […] Children born to mothers with ICP were more likely to be diagnosed with neurodevelopmental conditions. […] The primary strength of this study is our large nationwide sample, which allowed us to examine a population with minimal selection bias and loss to follow-up and to utilize robust methods to mitigate unobserved genetic and environmental confounders strengthening our causal inferences beyond that of traditional methods. […] In this large population-based cohort study, we found evidence to suggest that offspring exposed to ICP during pregnancy are more likely to be diagnosed with neurodevelopmental conditions, especially when exposed to early-onset ICP.

• #27 ICP Overview for Healthcare Professionals – ICP Care

  https://icpcare.org/healthcare-provider/icp-overview/

  Intrahepatic Cholestasis of Pregnancy (ICP) is a pregnancy-specific liver disorder in which bile transport through the liver is altered leading to elevated serum bile acids. The majority of cases occur in the second and third trimesters, but there have been cases reported in the literature as early as five weeks. […] The etiology of ICP is complex and not fully understood. Several factors are known or suspected to contribute. […] Intrahepatic Cholestasis of Pregnancy risk is increased in patients with other liver disorders such as Hepatitis C and autoimmune hepatitis. […] The main maternal effect of Intrahepatic Cholestasis of Pregnancy (ICP) is pruritus which can be severe and debilitating. ICP is also linked with an increased risk of gestational diabetes and pre-eclampsia. […] The prevalence of spontaneous preterm delivery may be as high as 20-40% without active management but appears to be reduced with active management.

• #28 Society for Maternal-Fetal Medicine Consult Series #53: Intrahepatic Cholestasis of Pregnancy

  https://www.contemporaryobgyn.net/view/society-for-maternal-fetal-medicine-consult-series-53-intrahepatic-cholestasis-of-pregnancy

  ICP is associated with several adverse perinatal outcomes, including stillbirth, meconium-stained amniotic fluid, and preterm birth (both spontaneous and iatrogenic). Data suggest that the risk of stillbirth with ICP is associated with the total bile acid concentration, although some level of risk may still be present even with low bile acid concentrations. […] The risk of recurrence of ICP in subsequent pregnancies may be as high as 90%, although data are insufficient to counsel patients on specific ranges. Some data also suggest that patients with a history of ICP are at higher risk for developing later hepatobiliary disease, particularly within the first year after the diagnosis of ICP.

• #29 Prevalence and risk factors of intrahepatic cholestasis of pregnancy in a Chinese population | Scientific Reports

  https://www.nature.com/articles/s41598-020-73378-5

  The incidence of 6.06% ICP found in the current study was comparable with findings of other cities in China, but it was higher than that reported in the neighboring countries like Punjab Pakistan. […] Our studies provide new understandings of ICP, which may facilitate the prioritization of medical interventions, resource assignments and policy making. In particular, our results may aid the prediction of pregnancies with a high risk of ICP, providing clinicians with time to plan and strategize their patients maternal/fetal surveillance and care.

• #30 Global and regional incidence of intrahepatic cholestasis of pregnancy: a systematic review and meta-analysis | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-025-03935-0

  Countries with low and middle income 3.5% [2.9%, 4.1%] and developing economies had a higher incidence of ICP compared to high-income countries 2.1% [1.7%, 2.6%]. […] This systematic review and meta-analysis indicated that ICP is detectable in 2.9% [2.5%, 3.3%] of pregnant women worldwide; however, the incidence widely differs across countries, with Germany, Hungary, Ukraine, Russia, India, Ireland, and China having the highest incidence and Bolivia, Slovenia, Malaysia, Croatia, Saudi Arabia, Mexico, and Australia having the lowest incidence of ICP. […] A lower incidence of ICP was found in high-income and developed countries. […] Among the continents, the incidence of ICP was higher in South America and Asia while lower in Oceania and North America. […] Given the significant differences between regions and ethnicities in the incidence of ICP and the critical consequences of this medical condition, future large-scale prospective studies should identify the factors predicting ICP and unravel the genetic basis of this medical condition.

• #31

  https://www.jci.org/articles/view/68927

  Intrahepatic cholestasis of pregnancy (ICP), marked by elevated maternal serum bile acid levels, occurs in late pregnancy and is often associated with poor perinatal outcomes. […] The influence of ICP on the metabolic health of offspring is unknown. We analyzed the Northern Finland birth cohort 19851986 database and found that 16-year-old children of mothers with ICP had altered lipid profiles. […] We believe this is the first report showing that cholestatic pregnancy in the absence of altered maternal BMI or diabetes can program metabolic disease in the offspring. […] ICP is the most common liver-specific disease of pregnancy that affects up to 2% of pregnant women in different populations and is associated with maternal hypercholanemia and dyslipidemia. […] To the best of our knowledge, we show for the first time, supported by several lines of evidence, that cholestatic pregnancy can program metabolic disease in the offspring.

• #32

  https://www.jci.org/articles/view/68927

  We also found levels of lipids in umbilical cord serum from ICP cases to be increased at term. […] Collectively, these data suggest that no factors other than maternal hypercholanemia in ICP affected the metabolic phenotype of term and adolescent offspring. […] We therefore conclude that maternal hypercholanemia in mice and humans has long-term implications for the health of their male and female offspring. […] This is consistent with the thrifty phenotype hypothesis, in which fetal adaptations to survive a poor intrauterine environment are preserved throughout life. […] To our knowledge, this is the first direct evidence showing that cholestatic pregnancy can program metabolic disease in the offspring.

• #33 Asymptomatic intrahepatic cholestasis of pregnancy

  https://www.oatext.com/asymptomatic-intrahepatic-cholestasis-of-pregnancy.php

  Apart from patients with the classic symptomatic variant of ICP associated with pruritus, some pregnant women have abnormal findings consistent with a asymptomatic/ latent/ subclinical form of ICP without pruritus. Since there are no significant differences in the clinical presentation, the rate of pregnancy complications and the severity of laboratory abnormality in ICP patients with or without pruritus, ICP not associated with pruritus may suggest the existence an asymptomatic (subclinical) ICP variant. […] The repeated BA determination is an appropriate option to monitor the effectiveness of treatment in asymptomatic ICP women. In view of the increased risk of fetal complications in women with ICP, pregnant women should undergo BAs screening to detect asymptomatic/ subclinical cases.

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