Maternal and Fetal Outcomes in Mothers with Intrahepatic Cholestasis of Pregnancy Compared to Healthy Pregnant Women: A Case-Control Study

Abstract

Background: Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder characterized by the accumulation of bile acids in maternal blood, potentially leading to adverse maternal and fetal outcomes. Objectives: The present study aimed to compare maternal and fetal outcomes between women with ICP and healthy pregnant women. Methods: A case-control study was conducted at Imam Khomeini Hospital, a major tertiary care center in Ahvaz, including 111 pregnant women diagnosed with ICP (cases) and 111 age-matched healthy pregnant women (controls) between 2019 and 2023. Data were collected via a checklist, including demographics, pregnancy-related variables, and maternal and fetal outcomes. The ICP was diagnosed based on pruritus and serum bile acid levels ≥ 10 μmol/L. Statistical analyses included t-tests and chi-square tests to compare continuous and categorical variables, respectively (P < 0.05). Results: Women with ICP exhibited significantly elevated AST and ALT compared to controls (P < 0.001). Uterine measurements, both right and left, were also higher in the ICP group (P = 0.006 and P = 0.04, respectively). Regarding fetal outcomes, the ICP group had a significantly higher rate of preterm delivery (24.32% vs. 3.60%, P < 0.001), respiratory distress syndrome (RDS) (7.21% vs. 0.9%, P = 0.035), lower neonatal birth weights (2991.18 ± 836.70 g vs. 3173.88 ± 438.42 g, P = 0.043), and increased NICU admissions (18.92% vs. 6.31%, P = 0.008). No cases of neonatal death or stillbirth were reported in either group. Conclusions: The ICP is associated with significant alterations in both maternal characteristics and adverse fetal outcomes, highlighting the need for early diagnosis, close monitoring, and proactive management. The increased rates of preterm delivery, neonatal RDS, and lower birth weight warrant careful consideration and potentially earlier intervention.