The impact of intrahepatic cholestasis on pregnancy outcomes: a retrospective cohort study

Abstract

Background This study analyzed the pregnancy outcomes of patients with intrahepatic cholestasis of pregnancy (ICP) in Hangzhou, China. Methods Cases of pregnant women monitored by antepartum testing at Hangzhou Women’s Hospital from January 2018 to December 2020 were reviewed. Subjects were classified into two groups according to whether they had ICP: 688 cases of ICP were assigned to an exposure group while 38,556 cases of non-ICP were assigned to a non-exposed group. Univariate analysis was performed on qualitative or quantitative data using the Chi-Squared test or Mann–Whitney U test, and the adjusted odds ratio (aOR) and 95% confidence interval (CI) of the two groups of related variables were calculated by multivariate binary logistic regression analysis. Results The incidence rate of ICP was 1.75%. Pregnant women with hepatitis B virus were correlated with ICP. Hepatitis B carriers (aOR = 3.873), preeclampsia (PE, aOR = 3.712), thrombocytopenia (aOR = 1.992), gestational hypertension (GH, aOR = 1.627), hyperlipidemia (aOR = 1.602) and gestational diabetes mellitus (GDM, aOR = 1.265) were all risk factors for ICP. In contrast, Body Mass Index (BMI) ≥ 30 kg/m2 (aOR = 0.446), 25 m2 < maternal BMI < 29.9 kg/m2 (aOR = 0.699) and parity ≥ 1 (aOR = 0.722) were protective factors for ICP. Pregnant women in the ICP group had an increased risk of gestation days < 259 days (aOR = 4.574) and cesarean delivery (aOR = 1.930) after ICP, and a decreased risk of longer gestational days (aOR = 0.105), premature rupture of membranes (aOR = 0.384) and fetal macrosomia (aOR = 0.551). Conclusions By analyzing a Chinese population with ICP, we identified that pregnant women who are hepatitis B carriers or with PE, thrombocytopenia, GH, hyperlipidemia, and GDM are at higher risk of ICP. Moreover, ICP is associated with adverse pregnancy outcomes; in particular, ICP may increase the incidence of shorter gestational days and non-vaginal delivery methods such as cesarean section but reduce the incidence of premature rupture of membranes and fetal macrosomia.

Clinical Management Guidelines for Intrahepatic Cholestasis of Pregnancy

“…A cohort study of 39,742 pregnant women showed that maternal age younger than 25 years or older than 35 years, low or high prepregnancy body mass index (BMI), being positive for hepatitis B surface antigen, multiple pregnancies, low maternal education level, insufficient pregnancy weight gain, in vitro fertilization, history of cesarean delivery, or history of two or more miscarriages were all associated with an increased risk of ICP 7 . In addition to these factors, a retrospective study of 39,244 pregnant women found that those with gestational hypertension, preeclampsia, thrombocytopenia, hyperlipidemia, and gestational diabetes mellitus (GDM) had a higher risk of ICP than others 8 . Among the ICP patients, those with GDM, a history of ICP, previous cholecystectomy, and smoking history were more likely to develop severe ICP (TBA concentration, >100 μmol/L) 9 .…”

Role of aspartate aminotransferase to platelet ratio in the prediction and prognosis of intrahepatic cholestasis of pregnancy: A case–control study from a tertiary center

“…Chen et al found that patients with ICP had increased risk of preterm birth and low birth weight, as well as a higher CS ratio. 6 A meta-analysis also showed the increased risk of preterm birth, iatrogenic preterm birth, meconium-stained amniotic fluid, and NICU admission in the ICP group compared with the control group. The risk of stillbirth was significantly higher in women with ICP when serum bile acid concentrations were ≥100 μmol/L.…”

“…Unfavorable perinatal outcomes related to ICP have been demonstrated in many studies. Chen et al found that patients with ICP had increased risk of preterm birth and low birth weight, as well as a higher CS ratio 6 . A meta‐analysis also showed the increased risk of preterm birth, iatrogenic preterm birth, meconium‐stained amniotic fluid, and NICU admission in the ICP group compared with the control group.…”

Genetically predicted lipids mediate the association between intrahepatic cholestasis of pregnancy and cardiovascular disease

“…This study focused on the role of dyslipidemia in abnormal pathophysiologic processes. Research by Chen Y et al demonstrated a higher prevalence of hyperlipidemia in individuals with ICP compared to those without (5.96% vs. 3.80%), identifying ICP as an independent risk factor for dyslipidemia ( 35 ). Building on this, our study employed mediator MR analysis to substantiate the significant indirect effect of ICP on CVD via lipid levels.…”