(1099) Early vs. Late Cholestasis of Pregnancy: A Comparative Study of Clinical Features and Pregnancy Outcomes

To compare adverse pregnancy outcomes in intrahepatic cholestasis of pregnancy (IHCP) stratified by timing of diagnosis: Early versus Late.

Study Design:

A retrospective cohort study of all IHCP cases at a single center (July 2014–January 2022). Pregnancies were grouped by the timing of diagnosis:1.  Early (< 28 W) and 2. Late (≥28 W). Parametric and non-parametric tests were used to compare clinical and obstetric outcomes. In addition, multivariable linear regression analysis was performed to identify factors independently associated with gestational age (GA) at delivery.

Results:

A total of 345 individuals were included: 1. 49 with early-onset and 2.  296 with late-onset IHCP. Early-onset cases had higher rates of prior preterm labors (PTL) (30.6% vs. 15.5%, P=0.015). Moderate IHCP (Total Bile Acids (TBA) ≥ 40 μM) was more frequent in early-onset cases (42.2% vs. 28.7%, P=0.047), with earlier treatment initiation (median 27, IQR 24-29 vs. 34, IQR 32-35 W, P< 0.001) and a higher rate of rifampin use (12.2% vs. 3.4%, P=0.016). All other baseline characteristics were comparable (Table 1).

Early-onset IHCP was associated with lower GA at delivery (median 36, IQR 32.5-37 vs. 36, IQR 35-37 W, P=0.013), higher rates of PTL< 34 W (26.5% vs. 6.4%, p< 0.001), more cesarean deliveries (49% vs. 31%, p=0.014), and fewer labor inductions (49% vs. 63.9%, p=0.047). Rates of PTL< 37 W, PPROM, and IUFD were comparable.

Neonates in the early-onset group had higher NICU admissions, lower birthweights and Apgar scores, though SGA rates were similar (Table2).

On regression analysis, GA at symptom onset was positively associated with GA at delivery (B=0.107, p< 0.001), while higher TBA levels (B=–0.016, p< 0.001) and twin gestation (B=–1.471, p< 0.001) were associated with earlier delivery. Other variables, including maternal age, pre-pregnancy BMI, smoking status, primiparity, previous PTL and history of cholestasis were not significantly associated with GA at delivery.

 

Conclusion:

Early-onset IHCP is linked to more severe disease, higher rates of early PTL, and increased neonatal morbidity compared to late-onset IHCP.