Delhi: Disease severity of intrahepatic cholestasis of pregnancy (IHCP) is associated with an increased risk for spontaneous preterm labor and meconium staining, reveals a recent study. The study appears in the American Journal of Obstetrics & Gynecology.
IHCP is a liver disorder that occurs during pregnancy. It impairs the release of a digestive fluid called bile from liver cells and as a result bile builds up in the liver, impairing liver function.

Previous studies have shown IHCP to be associated with adverse pregnancy outcomes including sudden intrauterine fetal demise and fetal cardiac arrhythmias. This association is related to total bile acid (TBA) levels as a marker for disease severity. However, studies have not determined if IHCP severity is associated with other adverse neonatal outcomes. To determine the same, the researchers conducted a retrospective cohort study of singleton, non-anomalous gestations complicated by IHCP at Elmhurst Hospital Center from 2005-2019.
IHCP severity was defined by peak TBA levels (mmol/L): mild (TBA 10-19), low moderate (TBA 20-39), high moderate (TBA 40-99), and severe (TBA >100). The researchers examined rates of preterm prelabor rupture of membranes (PPROM), fetal growth restriction (FGR), meconium, spontaneous preterm labor (sPTL), cesarean section (CS) for non-reassuring fetal heart tracing (NRFHT), umbilical artery pH, NICU admission, and neonatal birthweight. The association of IHCP severity and adverse neonatal outcomes were determined. Mild IHCP was used as the base comparator in all analyses.

Following were the study's key findings:
· Of the 1202 pregnancies complicated by IHCP, 306 (25.5%) were mild, 449 were low moderate (37.4%), 327 were high moderate (27.2%), and 120 were severe (10.0%).
· After adjusting for confounders, progressive IHCP severity was associated with risk for sPTL (low moderate aOR 1.63; high moderate aOR 3.68; severe aOR 6.45) and meconium (low moderate aOR 1.33;high moderate aOR 2.66; severe aOR 3.87).
· There was no significant association between IHCP severity and other adverse obstetric outcomes.
"Findings suggest that IHCP disease severity is associated with increased risk for spontaneous preterm labor and meconium staining," the researchers concluded.