INTRAHEPATIC CHOLESTASIS OF PREGNANCY AND POOR PERINATAL OUTCOMES: A PROSPECTIVE STUDY

Abstract

Objective: 

This prospective study aimed to investigate the association between Intrahepatic Cholestasis of Pregnancy (ICP) and adverse perinatal outcomes.

Methods: A prospective cohort study was conducted with 150 pregnant women, comprising 75 diagnosed with ICP (serum total bile acids ≥19 µmol/L with pruritus) and 75 healthy controls. Participants were recruited between 28-34 weeks of gestation and followed until delivery. Baseline characteristics, serum bile acids, and liver function tests were compared. The primary outcomes measured were preterm birth, meconium-stained amniotic fluid, low 5-minute Apgar score, NICU admission, stillbirth, and low birth weight.

Results: 

The ICP group had significantly elevated serum bile acids (24.3 ± 5.9 µmol/L vs. 6.8 ± 2.1 µmol/L, p<0.001) and liver transaminases compared to controls. Adverse perinatal outcomes were significantly more frequent in the ICP group (64.0% vs. 30.6%, p<0.001). Specifically, the ICP group had higher rates of preterm birth (29.3% vs. 10.6%; RR=2.76, p=0.004), meconium-stained amniotic fluid (24.0% vs. 8.0%; RR=3.00, p=0.010), low birth weight (26.6% vs. 12.0%; RR=2.22, p=0.028), and NICU admission (22.6% vs. 9.3%; RR=2.43, p=0.022).

Conclusion: 

Intrahepatic Cholestasis of Pregnancy is significantly associated with an increased risk of poor perinatal outcomes. Elevated maternal serum bile acids are directly correlated with these complications, underscoring the necessity for early diagnosis, close antenatal monitoring, and timely delivery to mitigate neonatal risks.