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Authors’ Response: Re: Intrahepatic cholestasis of pregnancy is not associated with stillbirth in an Australian maternity population - Corrected Proof

13 Mar 2014

We welcome the comments from Bannister-Tyrrell et al. concerning the incidence of stillbirth complicating ICP during an era of active management. It is noteworthy that the incidence of ICP was comparable in both study groups (USA and Australia) and that the risk of GDM in ICP was similar (OR 1.7). In the three cases associated with ICP in our study a maximal serum bile acid of over 100μmol/L had been recorded during the pregnancy (severe ICP). The mothers were all Hispanic, aged between 24 and 30 years with no diagnosis of obesity or GDM recorded prior to confirmation of fetal demise. One stillbirth was reported at 30 weeks and the other two occurred at 37 weeks’ gestation. The association of ICP with an increased incidence of stillbirth has previously been reported Whilst we accept that our findings may reflect a chance finding, it is interesting to note that the biochemical features are consistent with the recently published study by Geenes et al. that reported an increased incidence of adverse pregnancy outcomes in severe intrahepatic cholestasis of pregnancy (n=664) with maternal serum bile acids ≥40μmol/L . It is important that the Geenes study did not show an association between adverse pregnancy outcome and the maternal serum levels of ALT or bilirubin. Thus we believe it is important to consider the maternal serum bile acid level when evaluating adverse pregnancy outcomes in ICP.

13 March 2014

Click here to view the full article which appeared in European Journal of Obstetrics & Gynecology and Reproductive Biology

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