The prevalence of ICP varies greatly according to country.
The aim of this prospective study was to analyze the charac-
The prevalence is high in Scandinavian countries (1%teristics of intrahepatic cholestasis of pregnancy (ICP) in a 1.5%), 3,4 in Bolivia (9.2%), 5 and in Chile, with a prevalence French population. From 1989 to 1995 we studied 50 consecof between 11.8% and 27.6% according to ethnic origin. 6 In utive pregnant women with ICP (41 single, 7 twin, and 2
Santiago the prevalence of ICP was recently evaluated at 4%. 7 triplet pregnancies) referred for hepatologic consultation. All
In contrast, the prevalence is reported to be low in the United patients suffered from pruritus and/or jaundice associated
States, 8 Canada, 9 and Switzerland. 10 In France the prevalence with elevated fasting serum levels of total bile acids (mean has been assessed to be 0.2% to 0.5% 11,12 and ICP has not 49 mmol/L, range 7-290). No patients had concomitant liver often been studied. disease and all recovered normal liver function after delivery.
The aim of this prospective study was to analyze character-Overall prematurity rate was 60%: 100% in multiple pregnanistics of ICP in France. cies and 41% in single pregnancies. Three of 61 babies died. Systematic clinical interviews revealed that 34 patients had PATIENTS AND METHODS been treated with oral micronized natural progesterone (200-Patients 1,000 mg/d) during the current pregnancy for risk of premature delivery, including at least 32 (64%) before the onset of Fifty consecutive patients with ICP referred for hepatologic conpruritus. Onset of pruritus was statistically earlier in patients sultation from 1989 to 1995 were studied. The criteria for diagnosis previously receiving progesterone than in patients not receivof ICP were: 1) pruritus and/or jaundice; 2) increased serum total ing progesterone (217 { 21 vs. 240 { 26 days, P Γ΅ .01). bile acid (TBA) concentration and/or increased serum alanine ami- This was also found in the single pregnancy subgroup of notransferase (ALT) activity; 3) absence of current viral hepatitis and cytomegalovirus and Epstein-Barr virus infections; 4) absence patients (222 { 19 vs. 240 { 26 days, P Γ΅ .05). Pruritus of biliary tract dilatation on ultrasound examination; 5) absence of disappeared before delivery in 10 of 50 patients, i.e., after dermatological disease except lesions caused by scratching; and 6) withdrawal of progesterone in 7 patients (only one concurnormalization of routine liver function tests (LFTs) after delivery.
rently treated with cholestyramine), after decrease in dose of
Signs of pre-eclampsia, fever, and urinary or endocervical infection progesterone in 1 patient, and spontaneously in 2 patients.
were exclusion criteria. In cases of recurrent ICP the first occurrence During the same period, the percentage of pregnant women during the period under study was taken into account for the de- without ICP who had been treated with progesterone during scription of characteristics. pregnancy was statistically lower than the percentage of patients treated with progesterone before the onset of pruritus Methods in our group of patients with ICP (36% vs. 64%, P Γ΅ .01, Biological Tests. Fasting blood samples were taken and serum TBA odds ratio 3.16, 95% CI:1.29-7.80). These results suggest that and total bilirubin and conjugated bilirubin concentrations, and orally administered progesterone might be an exogenous facserum ALT, alkaline phosphatase (AP), and g-glutamyl transpepti- tor which triggers ICP in predisposed women. (HEPATOLOGY dase (GGT) activity, were measured at least twice, for each patient.