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World J Gastroenterol. Dec 14, 2007; 13(46): 6226-6230
Published online Dec 14, 2007. doi: 10.3748/wjg.v13.i46.6226
Predictors of premature delivery in patients with intrahepatic cholestasis of pregnancy
Jurate Kondrackiene, Ulrich Beuers, Rimantas Zalinkevicius, Horst-Dietmar Tauschel, Vladas Gintautas, Limas Kupcinskas
Jurate Kondrackiene, Limas Kupcinskas, Department of Gastroenterology, Kaunas University of Medicine, Kaunas, Lithuania
Ulrich Beuers, Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Rimantas Zalinkevicius, Institute of Endocrinology, Kaunas University of Medicine, Kaunas, Lithuania
Horst-Dietmar Tauschel, Dr. Falk Pharma GmbH, Freiburg, Germany
Vladas Gintautas, Department of Obstetrics and Gynecology, Kaunas University of Medicine, Kaunas, Lithuania
Author contributions: All authors contributed equally to the work.
Correspondence to: Jurate Kondrackiene, MD, PhD, Depart-ment of Gastroenterology, Kaunas University of Medicine, Eiveniu Street 2, Kaunas 50009, Lithuania. jukond@takas.lt
Telephone: +370-37-326896 Fax: +370-37-326508
Received: June 20, 2007
Revised: August 29, 2007
Accepted: September 26, 2007
Published online: December 14, 2007

AIM: To evaluate the predictive value of clinical symptoms and biochemical parameters for prematurity in intrahepatic cholestasis of pregnancy (ICP).

METHODS: Sixty symptomatic patients with ICP were included in this retrospective analysis. Preterm delivery was defined as delivery before 37 wk gestation. Predictors of preterm delivery were disclosed by binary multivariate logistic regression analysis.

RESULTS: Mean time of delivery was 38.1 ± 1.7 wk. No stillbirths occurred. Premature delivery was observed in eight (13.3%) patients. Total fasting serum bile acids were higher (47.8 ± 15.2 vs 41.0 ± 10.0 μmol/L, P < 0.05), and pruritus tended to start earlier (29.0 ± 3.9 vs 31.6 ± 3.3 wk, P = 0.057) in patients with premature delivery when compared to those with term delivery. Binary multivariate logistic regression analysis revealed that early onset of pruritus (OR 1.70, 95% CI 1.23-2.95, P = 0.038) and serum bile acid (OR 2.13, 95% CI 1.13-3.25, P = 0.013) were independent predictors of preterm delivery.

CONCLUSION: Early onset of pruritus and high levels of serum bile acids predict preterm delivery in ICP, and define a subgroup of patients at risk for poor neonatal outcome.

Keywords: Intrahepatic cholestasis, Delivery, Pregnancy