INTRAHEPATIC CHOLESTASIS OF PREGNANCY - A FRENCH PROSPECTIVE-STUDY

The aim of this prospective study was to analyze the characteristics o f intrahepatic cholestasis of pregnancy (ICP) in a French population. From 1989 to 1995 we studied 50 consecutive pregnant women with ICP (4 1 single, 7 twin, and 2 triplet pregnancies) referred for hepatologic consultation. All patients suffered from pruritus and/or jaundice asso ciated with elevated fasting serum levels of total. bile acids (mean 4 9 mu mol/L, range 7-290). No patients had concomitant liver disease an d all recovered normal liver function after delivery, Overall prematur ity rate was 60%: 100% in multiple pregnancies and 41% in single pregn ancies. Three of 61 babies died, Systematic clinical interviews reveal ed that 34 patients had been treated with oral micronized natural prog esterone (200-1,000 mg/d) during the current pregnancy for risk of pre mature delivery, including al least 32 (64%) before the onset of pruri tus. Onset of pruritus was statistically earlier in patients previousl y receiving progesterone than in patients not receiving progesterone ( 217 +/- 21 vs. 240 +/- 26 days, P < .01). This was also found in the s ingle pregnancy subgroup of patients (222 +/- 19 vs. 240 +/- 26 days, p < .01). Pruritus disappeared before delivery in 10 of 50 patients, i .e., after withdrawal of progesterone in T patients (only one concurre ntly treated with cholestyramine), after decrease in dose of progester one in 1 patient, and spontaneously in 2 patients. During the same per iod, the percentage of pregnant women without ICP Fc ho had been treat ed with progesterone during pregnancy was statistically lower than the percentage of patients treated with progesterone before the onset of pruritus in our group of patients with ICP (36% vs. 64%, P < .01, odds ratio 3.16, 95% CI:1.29-7.80). These results suggest that orally admi nistered progesterone might be an exogenous factor which triggers ICP in predisposed women.