Article
Obstetrics & Gynecology
J. Fleminger, P. T. Seed, A. Smith, E. Juszczak, P. H. Dixon, J. Chambers, J. Dorling, C. Williamson, J. G. Thornton, L. C. Chappell
Summary: The study found that there was no specific group of women with intrahepatic cholestasis of pregnancy who would benefit from treatment with ursodeoxycholic acid, indicating that its routine use for improvement of bile acid concentration or itch score should be reconsidered.
BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY
(2021)
Article
Gastroenterology & Hepatology
Tharni Vasavan, Sahil Deepak, Indu Asanka Jayawardane, Maristella Lucchini, Catherine Martin, Victoria Geenes, Joel Yang, Anita Lovgren-Sandblom, Paul Townsend Seed, Jenny Chambers, Sophia Stone, Lesia Kurlak, Peter Hendy Dixon, Hanns-Ulrich Marschall, Julia Gorelik, Lucy Chappell, Pam Loughna, Jim Thornton, Fiona Broughton Pipkin, Barrie Hayes-Gill, William Paul Fifer, Catherine Williamson
Summary: Elevated fetal and maternal serum bile acid concentrations in untreated ICP are associated with an abnormal fetal cardiac phenotype characterized by increased NT-proBNP concentration, PR interval length and HRV. UDCA treatment partially attenuates this phenotype.
JOURNAL OF HEPATOLOGY
(2021)
Review
Pharmacology & Pharmacy
Dan Shan, Siyu Dai, Qian Chen, Yupei Xie, Yayi Hu
Summary: This article reviews the current clinical evidence on the application of hepatoprotective agents in intrahepatic cholestasis of pregnancy (ICP) patients. The underlying physiological mechanisms and therapeutic effects of these agents in clinical practice are summarized. Limited clinical data demonstrate the reliable effectiveness and safety of these medications in ICP patients.
FRONTIERS IN PHARMACOLOGY
(2023)
Article
Genetics & Heredity
Przemyslaw Kosinski, Malgorzata Kedzia, Adrianna Mostowska, Pawel Gutaj, Michal Lipa, Ewa Wender-Ozegowska, Adriana Rozy, Joanna Chorostowska-Wynimko, Miroslaw Wielgos, Aleksandra Jezela-Stanek
Summary: The study revealed an increased prevalence of the SERPINA1 PI*Z variant in women with intrahepatic cholestasis, suggesting a possible genetic origin of a higher risk of intrahepatic cholestasis in pregnancy.
FRONTIERS IN GENETICS
(2021)
Article
Obstetrics & Gynecology
Miriam L. Estin, Alexa I. K. Campbell, Virginia Y. Watkins, Sarah K. Dotters-Katz, Carla W. Brady, Jerome J. Federspiel
Summary: This study, using a national database, found that patients with intrahepatic cholestasis of pregnancy delivered earlier but had lower stillbirth rates, which were not affected by gestational age at birth.
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
(2023)
Article
Medicine, General & Internal
Gal Hershkovitz, Yael Raz, Ilana Goldinger, Ariel Many, Liran Hiersch, Rimon Eli
Summary: Intrahepatic cholestasis of pregnancy (ICP) is characterized by elevated total bile acids (TBA). It is unclear why some fetuses are more prone to the hazardous effect of bile acids (BA) over the others. We aimed to compare TBA levels in umbilical vein and artery to maternal TBA in women with ICP. The study included 18 women and 23 fetuses, and we found that the TBA level in umbilical vein was significantly lower compared to maternal TBA level.
JOURNAL OF CLINICAL MEDICINE
(2023)
Review
Gastroenterology & Hepatology
Rebecca Roediger, Jaquelyn Fleckenstein
Summary: Intrahepatic cholestasis of pregnancy (ICP) is a common disorder in the second half of pregnancy with risks of adverse effects on the fetus. Although genetically susceptible, there is currently no proven preventive method, and ursodeoxycholic acid remains the first-line treatment option.
SEMINARS IN LIVER DISEASE
(2021)
Article
Obstetrics & Gynecology
Xiaomei Huang, Lei Lei, Fan Feng, Yong Shao
Summary: This study investigated the distribution of lipopolysaccharide in the maternal body and its effect on fetal outcomes in mice with intrahepatic cholestasis of pregnancy. The results showed significantly elevated levels of lipopolysaccharide in women with intrahepatic cholestasis of pregnancy, and in vivo fluorescence imaging revealed higher intensity of lipopolysaccharide in mice with intrahepatic cholestasis of pregnancy. Ursodeoxycholic acid and resveratrol treatment effectively reduced lipopolysaccharide levels in pregnant mice with intrahepatic cholestasis of pregnancy.
BMC PREGNANCY AND CHILDBIRTH
(2022)
Review
Obstetrics & Gynecology
Chidera Nneji Obiegbusi, Xiao Jing Dong, Samuel Chigbo Obiegbusi, Xiao Jin, Innocent Kenechukwu Okoene
Summary: This review summarizes the existing evidence on predictors of adverse fetal outcomes in pregnant women diagnosed with intrahepatic cholestasis of pregnancy (ICP). The identified predictors include in vitro fertilization (IVF) pregnancy, multifetal pregnancy, biochemical markers, gestational age of ICP onset, presence of comorbidities, maternal history of ICP, and hepatobiliary disease.
REPRODUCTIVE SCIENCES
(2023)
Review
Pharmacology & Pharmacy
Yinxiao Jiang, Haotian Li, Dan Song, Penghui Ye, Nuo Xu, Yuan Chen, Wenwen Zhang, Qichao Hu, Xiao Ma, Jianxia Wen, Yeyu Li, Yanling Zhao
Summary: This study found that the combined use of Chinese prescriptions or patent medicines with UDCA was generally more effective than using UDCA alone in the treatment of ICP, and the dosage of IP-f might be a beneficial therapeutic method for clinical medication of ICP.
FRONTIERS IN PHARMACOLOGY
(2021)
Article
Obstetrics & Gynecology
William M. Hague, Leonie Callaway, Jennifer Chambers, Lucy Chappell, Suzette Coat, Jiska de Haan-Jebbink, Marloes Dekker, Peter Dixon, Jodie Dodd, Maria Fuller, Sanne Gordijn, Dorothy Graham, Oskari Heikinheimo, Annemarie Hennessy, Risto Kaaja, Teck Yee Khong, Laura Lampio, Jennie Louise, Angela Makris, Corey Markus, Hanns-Ulrich Marschall, Philippa Middleton, Ben W. Mol, Jonathan Morris, John P. Newnham, Caroline Ovadia, Michael Peek, Antonia Shand, Michael Stark, Jim Thornton, Susanna Timonen, Susan Walker, David Warrilow, Catherine Williamson
Summary: Severe early onset intrahepatic cholestasis of pregnancy (ICP) affects 0.1% of pregnant women in Australia, with limited treatment options such as ursodeoxycholic acid (UDCA) and rifampicin. This study will be the first to examine the outcomes of treatment specifically in the severe early onset form of ICP, comparing the efficacy of rifampicin and UDCA, providing high-quality evidence for rifampicin use.
BMC PREGNANCY AND CHILDBIRTH
(2021)
Article
Obstetrics & Gynecology
Elena P. Lagon, Marti D. Soffer, Kaitlyn E. James, Keizra Mecklai, Darrick K. Li, Esperance A. Schaefer, Christina M. Duzyj
Summary: This study aimed to investigate the effects of delivery timing on maternal and neonatal outcomes in patients with intrahepatic cholestasis and found that prolonging pregnancy or delaying delivery can reduce neonatal morbidities associated with cholestasis.
AMERICAN JOURNAL OF OBSTETRICS & GYNECOLOGY MFM
(2022)
Article
Obstetrics & Gynecology
William M. Hague, Annette Briley, Leonie Callaway, Marloes Dekker Nitert, Jessica Gehlert, Dorothy Graham, Luke Grzeskowiak, Angela Makris, Corey Markus, Philippa Middleton, Michael J. Peek, Antonia Shand, Michael Stark, Jason Waugh
Summary: Intrahepatic cholestasis of pregnancy (ICP) is a liver disease during pregnancy characterized by itching and increased levels of total serum bile acids (TSBA), with an incidence of 0.6-0.7% in Australia. ICP is diagnosed by measuring TSBA and bile pigment in a pregnant woman with itching but no known pre-existing liver disorder. Severe and very severe disease are identified by TSBA levels of ≥40 and ≥100 μmol/L, respectively, with severe cases associated with spontaneous preterm birth and stillbirth in very severe cases. The effectiveness and risks of inducing preterm birth in ICP are still uncertain. Ursodeoxycholic acid is the recommended pharmacotherapy for ICP, improving perinatal outcomes and reducing itching, but its ability to reduce stillbirth has not been proven.
AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY
(2023)
Article
Gastroenterology & Hepatology
Akash Roy, Madhumita Premkumar, Saurabh Mishra, Rohit Mehtani, Vanita Suri, Neelam Aggarwal, Surender Singh, Radha Krishna Dhiman
Summary: ICP patients had higher incidence of pregnancy-induced hypertension, gestational diabetes and spontaneous preterm labor. Ursodeoxycholic acid (UDCA) was effective in treating symptoms of cholestasis in 79% of cases.
EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY
(2021)
Article
Obstetrics & Gynecology
Qianwen Zhang, Yu Xu, Yunhui Gong, Xinghui Liu
Summary: Assisted reproductive technology may increase the risk of early-onset intrahepatic cholestasis in twin pregnancies, but it does not seem to have adverse effects on bile acid levels and perinatal outcomes.
BMC PREGNANCY AND CHILDBIRTH
(2022)
Article
Health Care Sciences & Services
Lisa C. Zuckerwise, Madison M. Hustedt, Heather S. Lipkind, Edmund F. Funai, Cheryl A. Raab, Christian M. Pettker
JOURNAL OF PATIENT SAFETY
(2020)
Letter
Medicine, General & Internal
Katherine H. Campbell, Jean M. Tornatore, Kirsten E. Lawrence, Jessica L. Illuzzi, L. Scott Sussman, Heather S. Lipkind, Christian M. Pettker
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
(2020)
Review
Obstetrics & Gynecology
Katherine H. Campbell, Christian M. Pettker, Dena Goffman
SEMINARS IN PERINATOLOGY
(2020)
Article
Medicine, Research & Experimental
Hillary Hosier, Shelli F. Farhadian, Raffaella A. Morotti, Uma Deshmukh, Alice Lu-Culligan, Katherine H. Campbell, Yuki Yasumoto, Chantal B. F. Vogels, Arnau Casanovas-Massana, Pavithra Vijayakumar, Bertie Geng, Camila D. Odio, John Fournier, Anderson F. Brito, Joseph R. Fauver, Feimei Liu, Tara Alpert, Reshef Tal, Klara Szigeti-Buck, Sudhir Perincheri, Christopher Larsen, Aileen M. Gariepy, Gabriela Aguilar, Kristen L. Fardelmann, Malini Harigopal, Hugh S. Taylor, Christian M. Pettker, Anne L. Wyllie, Charles Dela Cruz, Aaron M. Ring, Nathan D. Grubaugh, Albert Ko, Tamas L. Horvath, Akiko Iwasaki, Uma M. Reddy, Heather S. Lipkind
JOURNAL OF CLINICAL INVESTIGATION
(2020)
Article
Obstetrics & Gynecology
Justin R. Lappen, Christian M. Pettker, Judette M. Louis
Summary: Comprehensive assessment of pregnancy-related risks in the United States is crucial in reducing maternal morbidity and mortality, with identification of high-risk women and early interventions being key. Healthcare practitioners need to be educated on factors contributing to high-risk pregnancies and the importance of risk assessment in reducing maternal morbidity and mortality across the reproductive spectrum.
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
(2021)
Article
Public, Environmental & Occupational Health
Scott C. Roberts, David R. Peaper, Craig D. Thorne, L. Scott Sussman, Thomas S. Murray, Steven J. Choi, Christian M. Pettker, Mark B. Russi, Richard A. Martinello
Summary: Mass asymptomatic SARS-CoV-2 testing of healthcare personnel at a large health system revealed a low prevalence of positive cases, with half of those testing positive having mild symptoms in hindsight. It is recommended that HCP with even mild symptoms should be isolated and tested.
INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY
(2021)
Article
Public, Environmental & Occupational Health
Scott C. Roberts, Michael J. Aniskiewicz, Steven J. Choi, Christian M. Pettker, Richard A. Martinello
INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY
(2022)
Letter
Medicine, General & Internal
Scott C. Roberts, David R. Peaper, L. Scott Sussman, Richard A. Martinello, Christian M. Pettker
Summary: This quality improvement study reports the outcomes of a mass preprocedure SARS-CoV-2 testing strategy during a period of high community transmission in Connecticut.
Article
Obstetrics & Gynecology
C. Andrew Combs, Dena Goffman, Christian M. Pettker
Summary: Hospital readmission is considered a core measure of quality in healthcare, but the maternal readmission rate after childbirth currently has limited utility as a metric for quality or performance improvement.
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
(2022)
Article
Obstetrics & Gynecology
Linda L. Fan, Sangini S. Sheth, Christian M. Pettker
Summary: This study aims to establish a sustainable and trackable process to understand the role of social determinants of health, bias, and racism in adverse gynecologic events. The study used a standardized health equity checklist and evaluated multiple gynecologic adverse events. The results showed that social determinants of health and implicit bias played a significant role in some adverse events.
OBSTETRICS AND GYNECOLOGY
(2022)
Editorial Material
Obstetrics & Gynecology
Linda L. L. Fan, Sangini S. S. Sheth, Christian M. M. Pettker
Summary: When evaluating unexpected medical adverse events after pharmaceutical, medical, or surgical treatment, it is important to investigate the roles of bias, systemic racism, and social determinants of health. Social determinants of health, including living environments, have a significant impact on clinical outcomes. Racial health disparities exist in various gynecologic procedures and outcomes, and investigating social determinants of health affecting patient outcomes is crucial. This study established a systematic and trackable process to determine the role of social determinants of health, bias, and racism in adverse gynecologic events.
OBSTETRICAL & GYNECOLOGICAL SURVEY
(2023)
Article
Medicine, Research & Experimental
Chrispin Chaguza, Andreas Coppi, Rebecca Earnest, David Ferguson, Nicholas Kerantzas, Frederick Warner, H. Patrick Young, Mallery Breban, Kendall Billig, Robert Tobias Koch, Kien Pham, Chaney C. Kalinich, Isabel M. Ott, Joseph R. Fauver, Anne M. Hahn, Irina R. Tikhonova, Christopher Castaldi, Bony De Kumar, Christian M. Pettker, Joshua L. Warren, Daniel M. Weinberger, Marie L. Landry, David R. Peaper, Wade Schulz, Chantal B. F. Vogels, Nathan D. Grubaugh
Summary: This study found that the odds of being infected with the Omicron variant were higher among vaccinated individuals compared to the Delta variant, and these odds increased with the number of vaccine doses. The positivity rates for the Delta variant were significantly reduced after two and three vaccine doses compared to unvaccinated individuals, while the positivity rate for the Omicron variant only significantly decreased after three doses.
Letter
Obstetrics & Gynecology
Christopher M. Zahn, Marc Jackson, Hyagriv N. Simhan, Christian M. Pettker
OBSTETRICS AND GYNECOLOGY
(2021)
Article
Obstetrics & Gynecology
Olga Grechukhina, Victoria Greenberg, Lisbet S. Lundsberg, Uma Deshmukh, Jennifer Cate, Heather S. Lipkind, Katherine H. Campbell, Christian M. Pettker, Katherine S. Kohari, Uma M. Reddy
AMERICAN JOURNAL OF OBSTETRICS & GYNECOLOGY MFM
(2020)