(582) Earlier diagnosis of severe cholestasis is associated with adverse pregnancy outcomes

Intrahepatic cholestasis of pregnancy (IHCP) has a severity associated relationship with adverse pregnancy outcomes including intrauterine fetal demise, spontaneous preterm labor, and meconium stained amniotic fluid. Studies have yet to determine if severe IHCP diagnosis earlier in pregnancy is associated with more adverse outcomes.

Study Design:

Retrospective cohort study of singleton, non-anomalous live gestations complicated by severe IHCP (peak total bile acids ≥ 40 μmol/L) from 2005-2019. We compared rates of adverse outcomes in pregnancies complicated by early severe (< 32 week gestational age) versus late severe (≥ 32 week gestational age) IHCP diagnosis. Primary outcome of interest was rates of spontaneous preterm labor resulting in preterm delivery. Secondary outcomes included rates of iatrogenic preterm birth, meconium stained amniotic fluid, cesarean delivery (CD) for non-reassuring fetal heart tracing (NRFHT), umbilical artery pH < 7.20, and neonatal intensive care unit (NICU) admission. Chi-square and multivariate regression tests determined the strength of association. In all analyses, a p-value < 0.05 and 95% CI not crossing 1.00 indicated statistical significance.

Results:

Of the 1247 pregnancies complicated by IHCP during the study period, 455 (36.5%) were complicated by severe IHCP. Among severe IHCP cases, 108 (23.7%) had early diagnosis and 347 (76.3%) had late diagnosis. Pregnancies with early severe IHCP had higher rates of prior preterm birth, higher incidence of ursodeoxycholic acid treatment, and were delivered at an earlier gestational age. Early severe IHCP was associated with spontaneous preterm labor, iatrogenic preterm birth, and NICU admission. After adjusting for confounders and baseline differences, early severe IHCP remained associated with spontaneous preterm labor (OR 2.41; 95% CI 1.34-4.34), iatrogenic preterm birth, (OR 1.67; 95% CI 1.05-2.67), and NICU admission (OR 1.66; 95% CI 1.06-2.61).

Conclusion:

Early severe IHCP is associated with adverse outcomes. Findings suggest increased duration of exposure to bile acids may contribute to adverse outcomes.