Liver disease in pregnancy linked to worse maternal, newborn outcomes
Pregnancy complication ICP tied to higher rates of infection, other issues
Intrahepatic cholestasis of pregnancy (ICP), the most common pregnancy-related liver disease, is significantly linked to higher rates of several maternal, fetal, and newborn issues and adverse outcomes, a review study found.
Maternal problems more frequently linked to ICP included infection, pregnancy-related high blood pressure, and high rates of Cesarean birth, known as a C-section, according to the review, which used pooled data from 10 published studies.
More frequent fetal and newborn problems tied to this liver disease in pregnancy included preterm birth — meaning a newborn is delivered before 37 weeks of gestation — low birth weight and height, and a greater likelihood of needed admission to the neonatal intensive care unit, or NICU.
“Based on these results, we recommend that pregnant individuals with ICP should be followed closely by health professionals,” the researchers wrote, adding that this “can be accomplished by increasing the quality and frequency of [pregnancy] follow-up, coordination with tertiary health care institutions, and birth in health care institutions with NICUs.”
Further, the team suggests that physicians and other healthcare professionals be educated about the potential effects of this liver disease during pregnancy.
“Pre- and postlicensure training programs should include the early diagnosis of ICP and awareness of associated adverse outcomes,” the researchers wrote.
The review study, “The Incidence of Intrahepatic Cholestasis of Pregnancy and its Maternal, Fetal, and Neonatal Adverse Outcomes: A Systematic Review and Meta-Analysis,” was published in the Journal of Midwifery & Women’s Health.
Liver disease during pregnancy found to occur in 1.7% of cases
ICP is a pregnancy complication marked by cholestasis, or stalled flow of bile, a digestive fluid made in the liver. This results in bile buildup in the liver, damaging the organ, and bile leakage into the bloodstream, causing symptoms such as itching.
The condition typically occurs during the third trimester of pregnancy, when there is an increase in the production of pregnancy hormones that can also affect bile flow. Several studies have linked this complication to worse outcomes for both parent and child.
However, the researchers noted that there are limited numbers of systematic reviews and meta-analyses focused on the frequency of ICP, and little data on its associated maternal, fetal, and newborn adverse outcomes.
Now, a team in Turkey systematically reviewed studies published between 2013 and 2023 that reported ICP frequency, as well as the frequency of adverse outcomes relative to pregnancies without such cholestasis. A total of 10 studies, conducted in China, France, India, the Netherlands, and Turkey, were reviewed in the meta-analysis.
Pooled data from all of the studies showed that the frequency of ICP was 1.7%. The researchers then compared the maternal outcomes of pregnant women with ICP versus those without.
Women with ICP had a significantly higher chance, by threefold, of experiencing maternal infection and pregnancy-related high blood pressure disorders, the researchers found. Moreover, they were nearly three times more likely to undergo a C-section.
If healthcare professionals providing care to pregnant individuals with ICP know these results, they can be prepared to detect and treat these adverse outcomes during pregnancy, labor, and postpartum.
No significant differences were seen between pregnancies with and without ICP regarding the likelihood of induced labor, pregnancy-related diabetes, postpartum bleeding, or abnormal amounts of amniotic fluid — the clear liquid that surrounds the fetus during pregnancy.
“If healthcare professionals providing care to pregnant individuals with ICP know these results, they can be prepared to detect and treat these adverse outcomes during pregnancy, labor, and postpartum,” the researchers wrote.
Babies born to mothers with ICP more likely to need NICU care
The team then conducted the same comparative analysis but on fetal and newborn adverse outcomes.
Pooled data showed that ICP was significantly associated with a fourfold higher likelihood of preterm birth or preterm premature ruptured membranes, which is when the mother’s water breaks early.
Newborns whose mothers had this liver disease during pregnancy also were more than twice as likely to be admitted to the NICU and to have low birth weight (weighing 2.5 kg, or about 5.5 pounds, or less) when compared with infants born to mothers without ICP. The chances that a baby was smaller than expected for the newborn’s gestational age were also nearly twice as high in the ICP group.
Conversely, the likelihood of both a birth weight greater than 4 kg (8.8 pounds) — heavier than expected for gestational age — and of perinatal death, when a baby dies between 28 weeks of gestation and the first seven days of life, were significantly lower in the ICP group.
“We believe that the low mortality rate in our review, despite the high rates of preterm birth and NICU admission, was due to the selection of studies that included participants with low-risk pregnancies and no other pregnancy complications,” the team wrote.
No significant differences were found between the two groups regarding abnormal fetal heart rate, the presence of meconium — a baby’s first stool — in the amniotic fluid, and an Apgar score below 7 five minutes after birth, which indicates potentially low blood oxygen levels.
These findings further support the association between ICP and increased risk of maternal, fetal, and newborn adverse outcomes, according to the researchers. Still, given the limited number of included studies in this meta-analysis, the results may not be generalized to all populations, the team noted.
Further research is needed, per the team.
“Given that ICP’s [development] involves genetic, [hormonal], and environmental factors along with geographical variations, high-quality research is needed to determine the impact of these factors on the incidence of ICP and its maternal, fetal, and neonatal adverse outcomes,” they concluded.
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