Intrahepatic cholestasis of pregnancy risks mothers, newborns

Babies from ICP mothers more likely to be preterm, have low birth weight

Andrea Lobo, PhD avatar

by Andrea Lobo, PhD |

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A drawing shows a pregnant woman cradling her belly with one hand and holding a teddy bear with the other.

Pregnant women with intrahepatic cholestasis of pregnancy (ICP) have an increased risk of other pregnancy-related problems, including gestational diabetes and preeclampsia, or sudden high blood pressure and organ dysfunction after 20 weeks of gestation.

That’s according to a study in Turkey that also found that babies from mothers with ICP were more likely to be born earlier, that is preterm, to have low weight at birth and signs of reduced oxygen blood levels, and to need intensive care after birth.

The findings further support that “ICP should prompt close monitoring and management to mitigate the potential exacerbation of adverse outcomes, including preeclampsia, GDM [gestational diabetes mellitus], and preterm birth,” the researchers wrote in “Intrahepatic cholestasis of pregnancy and its association with preeclampsia and gestational diabetes: a retrospective analysis,” which was published in Archives of Gynecology and Obstetrics.

ICP, the most common pregnancy-specific liver disease, is a form of cholestasis, a condition wherein the digestive fluid bile that’s produced in the liver doesn’t flow properly into the intestines. This causes bile acids to accumulate in the liver, impeding its function, and leak into the bloodstream, resulting in symptoms like severe itching. ICP typically occurs during the late stages of pregnancy, when pregnancy-related hormones, which can reduce bile flow, are at their highest levels.

Increasing data show the condition can increase the risk of major health problems for the mother and the developing fetus. These include preeclampsia and GDM, a common pregnancy complication marked by intolerance to blood sugar, or glucose, along with preterm birth, or before 37 weeks of gestation, and stillbirth.

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Adverse maternal, fetal outcomes

Here, researchers in Turkey reviewed adverse maternal and fetal outcomes of ICP and investigated the link between ICP and risk of GDM and preeclampsia to better examine the “relationship of ICP with GDM and preeclampsia.” From 1,686 pregnant women who gave birth at the Buca Seyf Demirsoy Training and Research Hospital in Izmir, Turkey from January 2018 to March 2022, 54 (3.2%) had ICP.

The women with ICP were significantly older (31 vs. 29.7), had higher pre-pregnancy body mass index (BMI), a ratio of height and weight (23.3 vs. 22.6, both within normal weight), and more often used assisted reproductive technology (7.4% vs. 2.5%) than those without ICP.

Also, a significantly higher proportion of those with ICP had preeclampsia (14.8% vs. 1.2%) and GDM (14.8% vs. 7%). the ICP group also had significantly higher rates of cesarean section delivery (72.2% vs. 48.5%), spontaneous preterm birth (3.7% vs. 0.7%), planned preterm birth (18.5% vs. 1%), and postpartum bleeding (3.7% vs. 0.9%).

Babies whose mothers had ICP were born significantly earlier (36.6 vs. 37.7 weeks) and with a significantly lower weight (2,847 vs. 3,127 g), than those whose mothers didn’t have ICP.

An Apgar score below 7 at five minutes, indicative of potentially low blood oxygen levels, and the need for neonatal intensive care were also significantly more frequent in babies who had mothers with ICP (3.7% vs. 0.9%).

Statistical analyses to identify potential risk factors of preeclampsia and GDM showed that having ICP was the only risk factor, being significantly associated with a 16 times higher risk of preeclampsia and a twofold higher risk of GDM.

“Consistent with previous studies, we demonstrated a higher risk of GDM and preeclampsia in women with ICP compared with those without ICP,” wrote the researchers, who said ICP “was associated with preterm birth and adverse perinatal outcomes.” Perinatal outcomes are those that occur in the period right before, during, and right after delivery.

Given that ICP is linked to “fetal death without any clear cause … it is advised to consider making delivery decisions based on bile acid levels to reduce the risks of ICP on stillbirth,” the researchers wrote. “With effective management during pregnancy, there was no increased incidence of stillbirth in our study.”

The researchers said the lack of an analysis of the potential link between blood bile acid levels and the risk of GDM or preeclampsia was a limitation of the study. “Therefore, it is necessary to further analyze the time frame for any relationship between ICP and GDM or preeclampsia and to better understand the potential mechanisms of any correlation,” they said.