ArticlePregnancy (Hoboken, N.J.)2025
Earlier diagnosis of intrahepatic cholestasis of pregnancy and adverse pregnancy outcomes.
Article in Pregnancy (Hoboken, N.J.), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionWe aimed to determine whether pregnancies complicated by early diagnosis of cholestasis were associated with adverse maternal or neonatal outcomes.
methodsThis is a retrospective cohort study of singleton, non-anomalous live gestations complicated by cholestasis from 2005-2019. We compared rates of adverse outcomes in pregnancies complicated by early (<32-week gestational age) versus late (≥ 32-week gestational age) diagnosis of cholestasis. Our primary outcome of interest was rates of spontaneous preterm birth. Secondary outcomes included rates of iatrogenic preterm birth, meconium-stained amniotic fluid, cesarean delivery for non-reassuring fetal heart tracing, and neonatal intensive care unit admission.
resultsOf the 1247 pregnancies complicated by cholestasis, 241 (19.3%) had early diagnosis and 1006 (80.7%) had late diagnosis. After adjusting for confounders including peak total bile acid levels, earlier diagnosis of cholestasis remained associated with spontaneous preterm birth (OR 1.81; 95% CI 1.11-2.95), iatrogenic preterm birth, (OR 1.59; 95% CI 1.12-2.67), and NICU admission (OR 1.43; 95% CI 1.04-1.95). A sub-analysis to compare outcomes with severe cholestasis (peak total bile acids ≥ 40 μmol/L) showed early diagnosis of severe cholestasis was also associated with spontaneous preterm labor (OR 2.41; 95% CI 1.34-4.34), iatrogenic preterm birth, (OR 1.67; 95% CI 1.05-2.67), and NICU admission (OR 1.66; 95% CI 1.06-2.61).
conclusionFindings suggests that earlier diagnosis of cholestasis is associated with adverse outcomes and that this is not entirely driven by peak total bile acid levels.
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