592: Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy

Abstract

To determine the predictors of adverse neonatal outcomes in patients with intrahepatic cholestasis of pregnancy (ICP). We conducted a multicenter retrospective cohort study of all women diagnosed with ICP across four hospital facilities from 2006 to 2013. ICP was diagnosed by maternal pruritis associated with total bile acid (TBA) levels > 10 μmol/L. We calculated the rate of severe neonatal morbidity (composite of neonatal intensive care unit admission, neonatal hyperbirilubinemia, hypoglycemia, respiratory distress syndrome, transient tachypnea of the newborn, mechanical ventilation use, need for neonatal oxygen with nasal cannula, pneumonia, and stillbirth) according to severity of bile acid elevation (mild ICP, TBA 10 to 39.9 μmol/L; moderate ICP, TBA 40 to 99.9 μmol/L; severe ICP, TBA >100 μmol/L). Mild ICP was used as a reference. Chi-Square and Fisher’s exact tests were used to compare outcomes. One-way analysis of variance (ANOVA), logistic regression, and receiver operating characteristic (ROC) curve were also used to predict neonatal complications. A total of 95 women with documented ICP were identified. There was no difference in maternal age, race, parity, or pre-pregnancy body mass index according to TBA level. There were 56 women with mild ICP, 25 with moderate ICP, and 14 with severe ICP. The rate of severe neonatal morbidity in mild, moderate and severe ICP was 22%, 48%, and 43% respectively (p=0.04) (Table). Women with moderate or severe IPC were more likely to deliver preterm at less than 37 weeks gestation compared to women with mild ICP (p=0.02). TBA above 39.8 μmol/L was associated with severe neonatal morbidity (p= 0.01, RR 2.12, 95%CI=1.16-3.87, AUC 0.67). There were two stillbirths at 29 and 35 weeks of gestation, both observed in women with severe ICP. Moderate and severe ICP were associated with severe neonatal morbidity and preterm delivery. TBA level above 39.8 μmol/L was associated with severe neonatal morbidity. Stillbirth was associated with severe ICP.