Beyond Stillbirth: Association of Intrahepatic Cholestasis of Pregnancy Severity and Adverse Outcomes

Abstract

(Am J Obstet Gynecol. 2022;227:517.e1–517.e7) While the incidence of intrahepatic cholestasis of pregnancy (IHCP) is infrequent (0.3% to 0.5%) in most regions, rates are elevated (15%) in certain populations and confer significant risk to the fetus. Maternal pruritus and elevated bile acids often begin in the second or third trimester, with the total bile acid (TBA) level being correlated to severity of disease and predictive of stillbirth. In addition to fetal demise, recent research has highlighted the association of IHCP with increased iatrogenic preterm birth, spontaneous preterm birth, respiratory distress syndrome and meconium-stained amniotic fluid. While severity-based analysis based on TBA levels is established for stillbirth, this study aimed to delineate an analysis of TBA correlation to other adverse outcomes beyond stillbirth.