{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T15:46:02Z","timestamp":1792597562730,"version":"4.5.0"},"reference-count":28,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2013,2,19]],"date-time":"2013-02-19T00:00:00Z","timestamp":1361232000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2013,5]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine the risk for adverse pregnancy and fetal outcomes in intrahepatic cholestasis of pregnancy (<jats:styled-content style=\"fixed-case\">ICP<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Population\u2010based cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>wedish Medical Birth Register (<jats:styled-content style=\"fixed-case\">MBR<\/jats:styled-content>) 1997\u20132009.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>A total of 1\u00a0213\u00a0668 singleton deliveries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Linkage of <jats:styled-content style=\"fixed-case\">H<\/jats:styled-content>ospital <jats:styled-content style=\"fixed-case\">D<\/jats:styled-content>ischarge <jats:styled-content style=\"fixed-case\">R<\/jats:styled-content>egister for exposure (<jats:styled-content style=\"fixed-case\">ICP<\/jats:styled-content>;<jats:italic> n<\/jats:italic>\u00a0=\u00a05477) with <jats:styled-content style=\"fixed-case\">MBR<\/jats:styled-content> for covariates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Gestational diabetes, pre\u2010eclampsia, prematurity, and stillbirth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Intrahepatic cholestasis (<jats:styled-content style=\"fixed-case\">ICP<\/jats:styled-content>) was diagnosed in 0.32\u20130.58% of all pregnancies, with an increasing trend until 2005 (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.0001). Compared with women who did not have <jats:styled-content style=\"fixed-case\">ICP<\/jats:styled-content>, women with <jats:styled-content style=\"fixed-case\">ICP<\/jats:styled-content> were more likely to have gestational diabetes (adjusted odds ratio, a<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>, 2.81; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 2.32\u20133.41) and pre\u2010eclampsia (a<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 2.62, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 2.32\u20132.78). Women with <jats:styled-content style=\"fixed-case\">ICP<\/jats:styled-content> were also more likely to have spontaneous (a<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 1.60, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.47\u20131.93) and iatrogenic (a<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 5.95, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 5.23\u20136.60) preterm delivery, with increased rates of induction of labour (a<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 11.76, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 11.04\u201311.62). However, this actively managed cohort of <jats:styled-content style=\"fixed-case\">ICP<\/jats:styled-content> cases was not at increased risk of stillbirth (a<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 0.92, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.52\u20131.62). Infants in <jats:styled-content style=\"fixed-case\">ICP<\/jats:styled-content> deliveries were more likely to have a low (&lt;7) 5\u2010minute <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>pgar score (a<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 1.45, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.14\u20131.85) and be large for gestational age at birth (a<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 2.27, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 2.02\u20132.55).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Over time, a greater proportion of <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>wedish pregnant women have received a diagnosis of <jats:styled-content style=\"fixed-case\">ICP<\/jats:styled-content>, probably because of an increased awareness of the disorder. Our data confirm an increased risk of preterm delivery, but not of stillbirth, in actively managed <jats:styled-content style=\"fixed-case\">ICP<\/jats:styled-content>. The high rates of gestational diabetes and pre\u2010eclampsia are new findings, and need to be considered in the management of <jats:styled-content style=\"fixed-case\">ICP<\/jats:styled-content> pregnancies.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.12174","type":"journal-article","created":{"date-parts":[[2013,2,19]],"date-time":"2013-02-19T18:12:40Z","timestamp":1361297560000},"page":"717-723","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":236,"title":["Intrahepatic cholestasis of pregnancy and associated adverse pregnancy and fetal outcomes: a 12\u2010year population\u2010based cohort study"],"prefix":"10.1111","volume":"120","author":[{"given":"E","family":"Wikstr\u00f6m Shemer","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Department of Clinical Sciences Karolinska Institutet Danderyd Hospital Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"HU","family":"Marschall","sequence":"additional","affiliation":[{"name":"Institute of Medicine Department of Molecular and Clinical Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JF","family":"Ludvigsson","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit Department of Medicine Solna Karolinska University Hospital and Institutet Stockholm Sweden"},{"name":"Department of Paediatrics \u00d6rebro University Hospital \u00d6rebro Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O","family":"Stephansson","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit Department of Medicine Solna Karolinska University Hospital and Institutet Stockholm Sweden"},{"name":"Department of Women's and Children's Health Karolinska University Hospital and Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,2,19]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)61495-1"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8278(00)80139-7"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.15.2049"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.20336"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.20952"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d6309"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.1996.tb14164.x"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-009-9350-y"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60279-6"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0707943"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(16)32430-9"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2002.01368.x"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2010.11.002"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1081\/PRG-120028278"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/10641950701581159"},{"key":"e_1_2_6_17_1","first-page":"387","article-title":"Obstetric cholestasis in Hong Kong\u2013local experience with eight consecutive cases","volume":"13","author":"Lo TK","year":"2007","journal-title":"Hong Kong Med J"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006250-199908000-00006"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.294.21.2751"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199801153380302"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60515-8"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.emboj.7601049"},{"key":"e_1_2_6_23_1","first-page":"678","article-title":"Targeting bile\u2010acid signalling for metabolic diseases","volume":"7","author":"Thomas C","year":"2008","journal-title":"Nat Rev"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.1128294"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.2337\/db10-0308"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0025006"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.3109\/07853890009011758"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21987"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.51.6.876"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; 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