Abstract
Twin pregnancies have a higher prevalence of intrahepatic cholestasis of pregnancy (ICP) than single pregnancies. It is unknown whether in vitro fertilization-embryo transfer (IVF-ET) influences the fetal outcomes in twin pregnancies complicated by ICP. This study aimed to explore the impact of IVF-ET on the perinatal outcomes of ICP in twin pregnancy. Clinical data from 142 twin pregnant women complicated with ICP were retrospectively analyzed, including 51 patients who conceived through IVF-ET (IVF group) and 91 patients with spontaneous conception (SC group). Several biochemical indicators and perinatal outcomes were analyzed. Compared to the SC group, the IVF group had a higher incidence of early-onset ICP (P = 0.015) and more frequent clinical symptoms (P = 0.020), including skin pruritus, skin scratch, and jaundice. Furthermore, the IVF group had higher rates of neonatal asphyxia (IVF vs. SC, 9.80% vs. 1.10%, P = 0.023) and premature delivery (IVF vs. SC, 96.08% vs. 83.52%, P = 0.027) compared to the SC group. The IVF-conceived twin pregnancy group had a higher risk of early-onset ICP and suffered from clinical symptoms and poor perinatal outcomes.
Highlights
Intrahepatic cholestasis of pregnancy (ICP) is a reversible pregnancy-associated liver disease that is characterized by elevated serum bile acids and an increased risk of deleterious consequences for the fetus, especially in the late second or third trimester[1,2,3]
The safety aspects of assisted reproductive technique (ART) for mother and fetus have been a concern since the introduction of the technology more than 30 years ago, and much of the risk is due to the increase of multiple gestations, which have increased risks for prematurity, perinatal mortality and morbidity[25]
The present study has addressed the impact of IVF on the perinatal outcome of twin pregnancy with intrahepatic cholestasis of pregnancy (ICP)
Summary
Intrahepatic cholestasis of pregnancy (ICP) is a reversible pregnancy-associated liver disease that is characterized by elevated serum bile acids and an increased risk of deleterious consequences for the fetus, especially in the late second or third trimester[1,2,3]. The influence of estrogen on ICP, the incidence of ICP was found to be elevated in IVF-conceived pregnancies compared to SC pregnancies[18,19]. Since assisted reproductive technique (ART) treatment increases the risk of adverse maternal complications of ICP18,19, we asked the following questions: Does IVF-ET influence the incidence of ICP in twin pregnancies? This study analyzed and compared the clinical features and fetal outcomes in twin pregnancies with ICP between IVF and SC pregnancies. Early-onset ICP has a severe consequence on the prognosis of offspring; we used it as a key parameter in this study
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