{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T01:41:40Z","timestamp":1793497300909,"version":"4.5.0"},"reference-count":43,"publisher":"Elsevier BV","issue":"2","license":[{"start":{"date-parts":[[2021,2,1]],"date-time":"2021-02-01T00:00:00Z","timestamp":1612137600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2021,2,1]],"date-time":"2021-02-01T00:00:00Z","timestamp":1612137600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["ajog.org","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["American Journal of Obstetrics and Gynecology"],"published-print":{"date-parts":[[2021,2]]},"DOI":"10.1016\/j.ajog.2020.11.002","type":"journal-article","created":{"date-parts":[[2020,11,13]],"date-time":"2020-11-13T04:11:46Z","timestamp":1605240706000},"page":"B2-B9","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":173,"title":["Society for Maternal-Fetal Medicine Consult Series #53: Intrahepatic cholestasis of pregnancy"],"prefix":"10.1016","volume":"224","author":[{"given":"Richard H.","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Mara Greenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torri D.","family":"Metz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian M.","family":"Pettker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.ajog.2020.11.002_bib1","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1111\/1471-0528.12174","article-title":"Intrahepatic cholestasis of pregnancy and associated adverse pregnancy and fetal outcomes: a 12-year population-based cohort study","volume":"120","author":"Wikstr\u00f6m Shemer","year":"2013","journal-title":"BJOG"},{"key":"10.1016\/j.ajog.2020.11.002_bib2","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1258\/om.2010.090055","article-title":"Pruritus in pregnancy: a study of anatomical distribution and prevalence in relation to the development of obstetric cholestasis","volume":"3","author":"Kenyon","year":"2010","journal-title":"Obstet Med"},{"key":"10.1016\/j.ajog.2020.11.002_bib3","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1097\/GRF.0000000000000080","article-title":"Dermatoses of pregnancy","volume":"58","author":"Bechtel","year":"2015","journal-title":"Clin Obstet Gynecol"},{"key":"10.1016\/j.ajog.2020.11.002_bib4","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1001\/archderm.143.6.757","article-title":"The importance of serum bile acid level analysis and treatment with ursodeoxycholic acid in intrahepatic cholestasis of pregnancy: a case series from central Europe","volume":"143","author":"Ambros-Rudolph","year":"2007","journal-title":"Arch Dermatol"},{"key":"10.1016\/j.ajog.2020.11.002_bib5","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1055\/s-0028-1103158","article-title":"Bile acid ratio in diagnosis of intrahepatic cholestasis of pregnancy","volume":"26","author":"Huang","year":"2009","journal-title":"Am J Perinatol"},{"key":"10.1016\/j.ajog.2020.11.002_bib6","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1111\/j.1471-0528.2011.03245.x","article-title":"Reference standard for serum bile acids in pregnancy","volume":"119","author":"Egan","year":"2012","journal-title":"BJOG"},{"key":"10.1016\/j.ajog.2020.11.002_bib7","first-page":"CD012546","article-title":"Total serum bile acids or serum bile acid profile, or both, for the diagnosis of intrahepatic cholestasis of pregnancy","volume":"7","author":"Manzotti","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"10.1016\/j.ajog.2020.11.002_bib8","doi-asserted-by":"crossref","first-page":"e168","DOI":"10.1055\/s-0035-1555128","article-title":"Bile acid determination after standardized glucose load in pregnant women","volume":"5","author":"Adams","year":"2015","journal-title":"AJP Rep"},{"key":"10.1016\/j.ajog.2020.11.002_bib9","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1002\/hep.21111","article-title":"Intrahepatic cholestasis of pregnancy as an indicator of liver and biliary diseases: a population-based study","volume":"43","author":"Ropponen","year":"2006","journal-title":"Hepatology"},{"key":"10.1016\/j.ajog.2020.11.002_bib10","doi-asserted-by":"crossref","first-page":"G1","DOI":"10.1152\/ajpgi.00028.2017","article-title":"Pregnancy and bile acid disorders","volume":"313","author":"Pataia","year":"2017","journal-title":"Am J Physiol Gastrointest Liver Physiol"},{"key":"10.1016\/j.ajog.2020.11.002_bib11","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1097\/AOG.0000000000001152","article-title":"Trends in stillbirth by gestational age in the United States, 2006-2012","volume":"126","author":"MacDorman","year":"2015","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2020.11.002_bib12","first-page":"1","article-title":"Fetal and perinatal mortality: United States, 2013","volume":"64","author":"MacDorman","year":"2015","journal-title":"Natl Vital Stat Rep"},{"key":"10.1016\/j.ajog.2020.11.002_bib13","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.ajog.2014.03.058","article-title":"Primum non nocere: how active management became modus operandi for intrahepatic cholestasis of pregnancy","volume":"211","author":"Henderson","year":"2014","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2020.11.002_bib14","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1111\/j.1471-0528.2004.00167.x","article-title":"Clinical outcome in a series of cases of obstetric cholestasis identified via a patient support group","volume":"111","author":"Williamson","year":"2004","journal-title":"BJOG"},{"key":"10.1016\/j.ajog.2020.11.002_bib15","doi-asserted-by":"crossref","first-page":"1482","DOI":"10.1002\/hep.26617","article-title":"Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: a prospective population-based case-control study","volume":"59","author":"Geenes","year":"2014","journal-title":"Hepatology"},{"key":"10.1016\/j.ajog.2020.11.002_bib16","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1042\/cs1000363","article-title":"The bile acid taurocholate impairs rat cardiomyocyte function: a proposed mechanism for intra-uterine fetal death in obstetric cholestasis","volume":"100","author":"Williamson","year":"2001","journal-title":"Clin Sci (Lond)"},{"key":"10.1016\/j.ajog.2020.11.002_bib17","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1042\/cs1030191","article-title":"Taurocholate induces changes in rat cardiomyocyte contraction and calcium dynamics","volume":"103","author":"Gorelik","year":"2002","journal-title":"Clin Sci (Lond)"},{"key":"10.1016\/j.ajog.2020.11.002_bib18","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/0028-2243(91)90222-7","article-title":"Vasoconstrictive effect of bile acids on isolated human placental chorionic veins","volume":"42","author":"Sep\u00falveda","year":"1991","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"10.1016\/j.ajog.2020.11.002_bib19","doi-asserted-by":"crossref","first-page":"100.e1","DOI":"10.1016\/j.ajog.2014.07.026","article-title":"Intrahepatic cholestasis of pregnancy: maternal and fetal outcomes associated with elevated bile acid levels","volume":"212","author":"Brouwers","year":"2015","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2020.11.002_bib20","doi-asserted-by":"crossref","first-page":"570.e1","DOI":"10.1016\/j.ajog.2015.06.021","article-title":"Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy","volume":"213","author":"Kawakita","year":"2015","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2020.11.002_bib21","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1016\/S0140-6736(18)31877-4","article-title":"Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses","volume":"393","author":"Ovadia","year":"2019","journal-title":"Lancet"},{"key":"10.1016\/j.ajog.2020.11.002_bib22","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1002\/hep.20336","article-title":"Intrahepatic cholestasis of pregnancy: relationships between bile acid levels and fetal complication rates","volume":"40","author":"Glantz","year":"2004","journal-title":"Hepatology"},{"issue":"2 Pt 2","key":"10.1016\/j.ajog.2020.11.002_bib23","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1097\/AOG.0b013e31818db1c9","article-title":"Sudden fetal death in intrahepatic cholestasis of pregnancy","volume":"113","author":"Lee","year":"2009","journal-title":"Obstet Gynecol"},{"issue":"2 Pt 2","key":"10.1016\/j.ajog.2020.11.002_bib24","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1097\/01.AOG.0000187951.98401.f7","article-title":"Fetal death in a patient with intrahepatic cholestasis of pregnancy","volume":"107","author":"Sentilhes","year":"2006","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2020.11.002_bib25","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1111\/jog.13399","article-title":"Bile acid levels and risk of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy: a meta-analysis","volume":"43","author":"Cui","year":"2017","journal-title":"J\u00a0Obstet Gynaecol Res"},{"key":"10.1016\/j.ajog.2020.11.002_bib26","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1067\/S0002-9378(03)00545-3","article-title":"Bile acids increase response and expression of human myometrial oxytocin receptor","volume":"189","author":"Germain","year":"2003","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2020.11.002_bib27","doi-asserted-by":"crossref","first-page":"395.e1","DOI":"10.1016\/j.ajog.2015.05.011","article-title":"Severe intrahepatic cholestasis of pregnancy is a risk factor for preeclampsia in singleton and twin pregnancies","volume":"213","author":"Raz","year":"2015","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2020.11.002_bib28","doi-asserted-by":"crossref","first-page":"1492","DOI":"10.1053\/j.gastro.2012.08.004","article-title":"Efficacy of ursodeoxycholic acid in treating intrahepatic cholestasis of pregnancy: a meta-analysis","volume":"143","author":"Bacq","year":"2012","journal-title":"Gastroenterology"},{"key":"10.1016\/j.ajog.2020.11.002_bib29","first-page":"CD000493","article-title":"Interventions for treating cholestasis in pregnancy","volume":"2013","author":"Gurung","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"10.1016\/j.ajog.2020.11.002_bib30","doi-asserted-by":"crossref","first-page":"e4949","DOI":"10.1097\/MD.0000000000004949","article-title":"Evaluating the effectiveness and safety of ursodeoxycholic acid in treatment of intrahepatic cholestasis of pregnancy: a meta-analysis (a prisma-compliant study)","volume":"95","author":"Kong","year":"2016","journal-title":"Medicine (Baltimore)"},{"key":"10.1016\/j.ajog.2020.11.002_bib31","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1016\/S0140-6736(19)31270-X","article-title":"Ursodeoxycholic acid versus placebo in women with intrahepatic cholestasis of pregnancy (PITCHES): a randomised controlled trial","volume":"394","author":"Chappell","year":"2019","journal-title":"Lancet"},{"key":"10.1016\/j.ajog.2020.11.002_bib32","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1097\/AOG.0000000000002794","article-title":"Adjuvant use of rifampin for refractory intrahepatic cholestasis of pregnancy","volume":"132","author":"Liu","year":"2018","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2020.11.002_bib33","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1111\/j.1471-0528.1981.tb00975.x","article-title":"Changes in serum bile acid concentrations during normal pregnancy, in patients with intrahepatic cholestasis of pregnancy and in pregnant women with itching","volume":"88","author":"Heikkinen","year":"1981","journal-title":"Br J Obstet Gynaecol"},{"key":"10.1016\/j.ajog.2020.11.002_bib34","first-page":"1190","article-title":"Pruritus may precede abnormal liver function tests in pregnant women with obstetric cholestasis: a longitudinal analysis","volume":"108","author":"Kenyon","year":"2001","journal-title":"BJOG"},{"key":"10.1016\/j.ajog.2020.11.002_bib35","doi-asserted-by":"crossref","first-page":"1913","DOI":"10.1080\/14767058.2017.1332036","article-title":"Perinatal outcomes associated with intrahepatic cholestasis of pregnancy","volume":"31","author":"Herrera","year":"2018","journal-title":"J\u00a0Matern Fetal Neonat Med"},{"issue":"4 Pt 1","key":"10.1016\/j.ajog.2020.11.002_bib36","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1016\/S0002-9378(96)80031-7","article-title":"Intrahepatic cholestasis of pregnancy: perinatal outcome associated with expectant management","volume":"175","author":"Alsulyman","year":"1996","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2020.11.002_bib37","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1136\/gut.37.4.580","article-title":"Fetal mortality associated with cholestasis of pregnancy and the potential benefit of therapy with ursodeoxycholic acid","volume":"37","author":"Davies","year":"1995","journal-title":"Gut"},{"key":"10.1016\/j.ajog.2020.11.002_bib38","doi-asserted-by":"crossref","first-page":"2254","DOI":"10.3109\/14767058.2014.984605","article-title":"Intrahepatic cholestasis of pregnancy and timing of delivery","volume":"28","author":"Lo","year":"2015","journal-title":"J\u00a0Matern Fetal Neonat Med"},{"key":"10.1016\/j.ajog.2020.11.002_bib39","doi-asserted-by":"crossref","first-page":"667.e1","DOI":"10.1016\/j.ajog.2015.02.012","article-title":"The risk of infant and fetal death by each additional week of expectant management in intrahepatic cholestasis of pregnancy by gestational age","volume":"212","author":"Puljic","year":"2015","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2020.11.002_bib40","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1002\/hep.26444","article-title":"Intrahepatic cholestasis of pregnancy and associated hepatobiliary disease: a population-based cohort study","volume":"58","author":"Marschall","year":"2013","journal-title":"Hepatology"},{"key":"10.1016\/j.ajog.2020.11.002_bib41","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.clinre.2016.07.004","article-title":"Hepatitis C infection and intrahepatic cholestasis of pregnancy: a systematic review and meta-analysis","volume":"41","author":"Wijarnpreecha","year":"2017","journal-title":"Clin Res Hepatol Gastroenterol"},{"key":"10.1016\/j.ajog.2020.11.002_bib42","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.ajog.2013.07.012","article-title":"SMFM adopts GRADE (Grading of Recommendations Assessment, Development, and Evaluation) for clinical guidelines","volume":"209","author":"Chauhan","year":"2013","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2020.11.002_bib43","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: an emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"}],"container-title":["American Journal of Obstetrics and Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0002937820312849?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0002937820312849?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T11:30:55Z","timestamp":1757590255000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0002937820312849"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2]]},"references-count":43,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,2]]}},"alternative-id":["S0002937820312849"],"URL":"https:\/\/doi.org\/10.1016\/j.ajog.2020.11.002","relation":{},"ISSN":["0002-9378"],"issn-type":[{"value":"0002-9378","type":"print"}],"subject":[],"published":{"date-parts":[[2021,2]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Society for Maternal-Fetal Medicine Consult Series #53: Intrahepatic cholestasis of pregnancy","name":"articletitle","label":"Article Title"},{"value":"American Journal of Obstetrics and Gynecology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ajog.2020.11.002","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2020 Published by Elsevier Inc.","name":"copyright","label":"Copyright"}]}}