Will ICP harm my baby?
ICP gives rise to several risks to your baby.
Preterm birth is defined as delivery before 37 weeks. In ICP this may occur because labour begins spontaneously before 37 weeks or because doctors recommend induction of labour before 37 weeks (known as iatrogenic preterm birth). Induction of labour is not an easy decision to make and there is little research to give clear guidance on this. Two papers that may help you to better understand the risks are Glantz et al. 2004 and Geenes et al. 2014 (PDF downloads).
Most specialists in the condition tend to aim for delivery at 37–38 weeks in their care plan, but it could be later or earlier than this depending on bile acid levels. Where women have extremely high bile acids some doctors are suggesting that delivery earlier than 37 weeks may be better (Geenes et al. 2014).
There is also research that suggests that if your bile acids have always been under 40 µmol/L you may be able to wait for spontaneous labour. However, this relies on a number of factors:
- That bile acids (and not something else) are the cause of stillbirth (researchers are still working on showing how this happens)
- A fast turn-round of bile acid results (within 24 hours)
- No in-depth study has been made of women who progress beyond 38 weeks
This is something that you will need to discuss with your own doctor to see what their views are. See our suggested guideline for diagnosis, treatment and management of ICP.
Meconium stainingMeconium is the first poo that a baby passes. In some cases the baby may poo before it is born. This is very common if the baby is overdue, but less common if not. In ICP there is an increased risk of the baby passing meconium before delivery, even if the baby is born prematurely. However, the PITCH trial (2009) showed that there was a reduction in meconium staining of the amniotic fluid for women taking UDCA, although this involved a relatively small number of women. A larger trial called PITCHES has now started to try to confirm this.
There is an increased risk of your baby being admitted to the neonatal unit, although many babies only stay a short while. In ICP common reasons for the baby being admitted to the neonatal unit are that they are born prematurely and need some extra help with breathing or feeding. Your doctor will be able to explain more about the reasons for admission to the neonatal unit and what it may mean for the baby.
There is also a suggestion that very high bile acids may impact on the production of lung surfactant in the fetus, which could result in something called ‘bile acid pneumonia’. This in turn increases the risk of admission to the neonatal unit for oxygen therapy (see Zecca 2004).
The most feared complication associated with ICP is stillbirth. Several studies have reported that stillbirth is more common in ICP than in uncomplicated pregnancies, but the reason for this is not clear – although as we have previously discussed this may be linked to high bile acid levels.
It has been reported that the risk of stillbirth in ICP is increased if there are also other complications of pregnancy, including pre-eclampsia and gestational diabetes. Current estimates of the risk of stillbirth in ICP are between 1% and 4%. This means that stillbirth is between 2 and 8 times more common than in uncomplicated pregnancies.