References

Abedin P, Weaver JB, Egginton E. Intrahepatic cholestasis of pregnancy: prevalence and ethnic distribution. Ethn Health. 1999; 4:(1–2)35-37 https://doi.org/10.1080/13557859998173

Chambers J. Understanding Intrahepatic Cholestasis of Pregnancy (ICP): The power of women coming together. AIMS Journal. 2021; 33:(2)

Chappell LC, Chambers J, Dixon PH Ursodeoxycholic acid versus placebo in women with intrahepatic cholestasis of pregnancy (PITCHES): a randomised controlled trial. Lancet. 2019; 394:(10201)849-860 https://doi.org/10.1016/S0140-6736(19)31270-X

ClinicalTrials.gov. A placebo-controlled study of volixibat in subjects with elevated serum bile acids associated with intrahepatic cholestasis of pregnancy (OHANA). 2021. https://clinicaltrials.gov/ct2/show/NCT04718961 (accessed 21 January 2022)

Dixon PH, Sambrotta M, Chambers J An expanded role for heterozygous mutations of ABCB4, ABCB11, ATP8B1, ABCC2 and TJP2 in intrahepatic cholestasis of pregnancy. Sci Rep. 2017; 7 https://doi.org/10.1038/s41598-017-11626-x

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Mitchell A, Ovadia C, Syngelaki A Re-evaluating diagnostic thresholds for intrahepatic cholestasis of pregnancy: case-control and cohort study. Br J Obstet Gynaecol. 2021; 128:(10)1635-1644 https://doi.org/10.1111/1471-0528.16669

Ovadia C, Seed PT, Sklavounos A Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. The Lancet. 2019; 393:(10174)899-909 https://doi.org/10.1016/S0140-6736(18)31877-4

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Why research is so important

02 February 2022
4 min read
Volume 30 · Issue 2

Abstract

Jenny Chambers discusses the developments in research about intrahepatic cholestasis of pregnancy in recent years, that has taken place with the help of the charity ICP Support

When I was diagnosed with intrahepatic cholestasis of pregnancy in 1991, there was nothing written about management of the condition in any institutional guidelines and most health professionals had not heard of it. It was sheer luck (although, following two stillbirths, I didn't feel quite so lucky at the time) that I was finally diagnosed by an obstetrician who had an interest in the condition and who worked with a hepatologist with an interest in intrahepatic cholestasis of pregnancy. Both were keen to conduct research into the disease, so during my final pregnancy I agreed to donate the samples they wanted as well as taking a new medication for the condition.

Intrahepatic cholestasis of pregnancy is the most common pregnancy-specific liver disease affecting around 5500 women a year in the UK (0.7%) (Abedin et al, 1999). There is a geographical spread to incidence of the condition; women whose family birth origins are South American, South Asian and Scandinavian are more likely to be affected (Ovadia and Williamson, 2016). Intrahepatic cholestasis of pregnancy is caused through a combination of genetics, hormones and environmental factors. Its main symptom, pruritus, can be so distressing for women that some have reported feeling suicidal (Chambers, 2021). Other symptoms include dark urine, steatorrhea and right upper quadrant pain (ICP Support, 2022). It is associated with fetal distress, spontaneous premature birth and, in severe cases, stillbirth (Ovadia et al, 2019). Diagnosis is made through liver bloods tests and more specifically, non-fasting bile acid tests.

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