977 Outcomes of intrahepatic cholestasis of pregnancy in women with a prior cholecystectomy

Abstract

Intrahepatic cholestasis of pregnancy (ICP) is characterized by pruritus in the setting of elevated serum bile acids (BA). While some studies have identified cholecystectomy (CCY) as a risk factor for developing ICP, little is known about the effects of prior CCY on the severity or outcomes of the disease. Our objective was to compare the maternal outcomes of women with and without prior CCY who developed ICP. This was a retrospective cohort study of patients diagnosed with ICP between 2012 and 2019 at a tertiary referral center. ICP was defined as symptomatic pruritus combined with serum BA ≥10 μmol/L. Maternal characteristics and outcomes were abstracted from electronic medical records and compared between those with and without prior CCY. Student’s t-test, Mann-Whitney U, Chi-squared or Fisher’s exact tests were used as appropriate. A p-value < 0.05 was considered statistically significant. 438 patients were included in the analysis. Women with diagnosed ICP shared similar baseline characteristics including age, race, and gestational age at diagnosis. Women with prior CCY were more likely to have severe disease (BA ≥100 μmol/L, 12% vs 2%, p<0.01) and despite no difference in history of prior cesarean section, were more likely to have a cesarean delivery (43% vs 28%, p=0.04). There was a trend of elevated AST in patients with prior CCY, though this was not statistically significant (45% vs 31%, p=0.05). There was no difference in the incidence of gestational diabetes, hypertensive disorders of pregnancies, fetal growth restriction, or preterm labor between the two groups. There was also no difference in a composite of adverse neonatal outcomes between those with and without a prior CCY (33 vs 29%, p=0.48). Women with ICP with prior CCY are more likely to have severe disease and a cesarean delivery. Serial bile acid measurements to evaluate for development of severe disease may be warranted in this population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)