Severe ICP raises risk in twin pregnancy, study finds
Bile acid levels linked to pregnancy outcome
Severe intrahepatic cholestasis of pregnancy (ICP) significantly raises the risks of adverse outcomes in twin pregnancies, according to a single-center, retrospective study conducted in China.
Adverse outcomes include preterm birth (before 37 weeks of gestation), lower birth weight, and the presence of meconium — a baby’s first stool — in the amniotic fluid.
The findings highlight “the need for further research to refine management strategies for ICP during twin pregnancies,” the researchers wrote.
The study, “Preterm birth and stillbirth: total bile acid levels in intrahepatic cholestasis of pregnancy and outcomes of twin pregnancies: a retrospective cohort study from 2014 to 2022,” was published in BMC Pregnancy and Childbirth.
Cholestasis arises when bile, a digestive fluid produced by the liver, fails to properly flow into the intestines, where it aids in food digestion. As a result, bile acids, the primary components of bile, can accumulate to toxic levels in the liver and enter the bloodstream, causing cholestasis symptoms.
Pregnancy risk heightened with twins
ICP is a type of cholestasis that occurs during pregnancy, typically in the second or third trimester. It is characterized by symptoms such as skin itching, jaundice, and elevated levels of bile acids in the blood.
Although it usually resolves after delivery, it poses potential risks for both the mother and the baby, particularly in the case of twins. While high circulating levels of bile acids serve as an important diagnostic indicator for ICP, monitoring is complicated by the fact that symptoms may appear before bile acid levels rise.
To assess the impact of ICP-related bile acids levels on twin pregnancy outcomes, the researchers retrospectively analyzed data from 1,156 women with twin pregnancies complicated by ICP, who were followed at a single hospital from January 2014 to July 2022.
ICP severity was classified based on peak bile acids levels during pregnancy. A total of 430 women had mild disease, 392 had moderate-low, 292 had moderate-high, and 42 had severe ICP.
Significant differences were observed across these groups regarding various pregnancy factors: the baby’s gestational age at diagnosis, bile acid levels at diagnosis and delivery, gestational age at pregnancy termination, rate of vaginal delivery, and preterm birth rate.
The severe (4.8%) and moderate-high ICP groups (7.5%) exhibited a significantly lower proportion of full-term pregnancies (at 37 weeks of gestation or later) when compared with the mild ICP group (25.6%). Conversely, the moderate-low and moderate-high ICP groups had significantly higher rates of late preterm births (between weeks 32-36 of gestation) than the mild group (79.3% and 85.6% vs. 68.8%).
While no significant differences were found in maternal-fetal complications, neonatal outcomes significantly differed between the groups, including in birth weight, proportion of infants with low birth weight, and rate of meconium-stained amniotic fluid.
The severe and moderate-severe groups showed higher rates of low birth weight and meconium-stained amniotic fluid relative to the mild group.
Meconium-stained amniotic fluid may indicate fetal distress and increase the risk of delivery complications, such as the newborn’s inhalation of a mixture of meconium and amniotic fluid into the lungs at birth. This can lead to breathing problems and other complications for the newborn.
The analysis also revealed 21 cases of intrauterine fetal death (1.82%). Most of these deaths (73.9%) occurred within one month after the diagnosis of ICP. No cases of intrauterine fetal death were detected in the severe ICP group.
These findings highlighted “a correlation between peak [bile acid] levels in ICP and adverse outcomes in twin pregnancies,” the researchers wrote. “Further research with larger [patient samples] is necessary to investigate the relationship between bile acid levels and the prognosis of twin pregnancies, which will assist clinicians in making more informed decisions.”
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