- A simple bile
acid blood test could prevent stillbirths in women with intrahepatic cholestasis of pregnancy (ICP)
- The blood test
could also help avoid unnecessary preterm births
- The discovery is
an important step forward in the diagnosis and management of liver disorders during pregnancy,
suggests a new study
cholestasis of pregnancy (ICP) is a liver disorder that occurs in pregnant
women, characterized by the
build-up of bile acids in the blood and the symptoms include
itching. ICP affects approximately 5,300 pregnancies in the UK, annually, and
more than 14 every day. It was earlier believed that higher risks of stillbirth
are related to increases in bile acid concentration. Therefore to prevent stillbirths
, pregnant women who showed symptoms of ICP were often
given the option of early induction of labor at around 37 weeks.
Details of the Study
A new study
conducted by a research team from Guy's and St Thomas' and King's College
London has found a way to measure the risk of stillbirth for women with ICP by
means of a simple blood test.
analyzed more than 170,000 pregnancies from 40 international studies in
order to comprehend the association between ICP, bile acid levels and
stillbirth. The study was funded by ICP Support, Tommy's, Genesis Research
Trust, Wellcome Trust and the NIHR.
Findings from the Study
of the study, published in The Lancet
show that the concentration of bile
acids in a pregnant woman's blood is linked to the probability of stillbirth as
a result of ICP.
It would now be possible to determine this using a simple
‘Simple bile acid blood test may help identify women at risk of stillbirth. The blood test also avoids unnecessary preterm births and is a step forward in diagnosing liver disorders during pregnancy.’
highly benefit from this study as they would be able to identify all pregnant
women who are at risk of stillbirth, requiring an intervention to prevent it.
Therefore women with ICP who are at low risk of carrying their pregnancy till
full term would also be at an advantage.
team believes that by implementing this test hundreds of women could be
prevented from having early deliveries unnecessarily.
Catherine Williamson, Consultant Obstetric Physician and Chair in Women's
Health at Guy's and St Thomas' and King's College London, also the study lead
remarked, "We are grateful to our
collaborators worldwide who have helped us perform the largest study to date,
the results of which will enable doctors to personalise treatment for women with
She added that "We can now
identify those women at the highest risk of stillbirth and consider
interventions to specifically prevent stillbirth in this group. We will also be
able to reassure a large number of women, who may have previously been concerned,
that they are not at increased risk of stillbirth."
women in the UK and 18,500 globally, at the moment, are having early
They account for more than 15 percent of women having bile
acids below the 100 micromoles per liter limit.
The risk of stillbirth for majority of women
with ICP, who have bile acid concentration below 100 micromoles per litre, when
compared to women without ICP is not significantly great.
do not require any further treatment during the rest of their pregnancy, other
than the regular bile acid blood tests.
Patron of ICP Support, Helen George, is certain that the results of the study
will be comforting news for many women with ICP. She said that "My own ICP pregnancy would have been less
anxiety-provoking with this latest information but I believe that it's also
incredibly important that women who itch continue to let their midwife or
doctor know so that they can be tested for the condition."
"This marks a real step forward in the & diagnosis and management of liver disorders during
pregnancy. Being able to measure the risks to women and their babies by simple
tests allows doctors to concentrate treatment on those who really need it,"
Caroline Ovadia, Chadburn Clinical Lecturer at King's College London.
"It also means that women will not have to be
offered preterm birth unnecessarily which comes with associated risks to their
babies including admission to neonatal units, breathing problems and jaundice. We are hopeful our findings will help to
improve pregnancy outcomes in high-risk women and allow thousands of pregnant women to be reassured
that their ICP does not pose a significant risk to themselves or their baby,"
CEO of ICP
Support, Jenny Chambers, who suffered two stillbirths because of the disorder
said, "We welcome the news that most
women with ICP will now be spared the anxiety of worrying about the possibility
of stillbirth. However, it important that health professionals realize that regular bile acid testing until
birth is vital to ensure that those women who are at greater risk aren't
Chief Executive of Tommy's mentioned, "Stillbirth
devastates parents' lives and Tommy's believes that too many babies still die
at full term. This study means that we can detect more otherwise healthy babies
who are at risk of sudden death because of their mother's liver condition. This
study has the potential to save lives if the practice is revised immediately and implemented nationally.
Importantly it will prevent babies from being induced early, which carries a
risk of lifelong negative consequences for them, and prevent the distress and
concern caused to parents who wrongly believe that their baby is at risk." References :
- Association of Adverse Perinatal Outcomes of Intrahepatic Cholestasis of Pregnancy with Biochemical Markers: Results of Aggregate and Individual Patient Data Meta-analyses - (https://doi.org/10.1016/S0140-6736(18)31877-4)