Impact of Prior History of Intrahepatic Cholestasis of Pregnancy on Current Pregnancy [33K

Abstract

INTRODUCTION: The purpose of this study was to determine the impact of a prior history of intrahepatic cholestasis of pregnancy (ICP) on current pregnancy course and outcome in women with subsequent ICP. METHODS: This is a retrospective cohort study, comparing multiparous patients with ICP who had a history of ICP in a prior pregnancy to those patients without a prior history. Data was collected from a single hospital between 2005 and 2013. All patients with a diagnosis of ICP were identified. Data collected included maternal demographics, ICP management, delivery and neonatal outcomes. Logistic regression was used to evaluate the overall odds of an adverse neonatal outcome for those with and without a history of ICP. RESULTS: We identified 529 multiparous pregnancies with ICP during this time, 420 (79.5%) had no prior history of ICP and 109 (20.5%) had a prior history. There were no differences in demographics between the groups. Women with a history of ICP were diagnosed 6 days sooner and were more likely to be treated with ursodiol. There were lower birthweights, higher rates of RDS, and meconium in those with a history of ICP. When adjusting for maternal demographics, prior ICP, and gestational or other diabetes, a history of ICP was not significantly associated with any adverse neonatal outcomes. CONCLUSION: Patients with a history of ICP have earlier diagnosis. There is a significantly higher rate of meconium, lower birthweight and a higher rate of RDS. This may be driven by delivery timing which serves as valuable information when counseling patients on pregnancy expectations.