Early delivery, low stillbirth rate seen with pregnancy-related liver disorder

Key takeaways:

• Stillbirth rates were lower among women with intrahepatic cholestasis of pregnancy vs. women without.
• Women with intrahepatic cholestasis of pregnancy had a higher likelihood of preterm delivery vs. women without.

Women with intrahepatic cholestasis of pregnancy delivered earlier and had a lower percentage of stillbirths compared with women without the liver disorder, researchers reported in the American Journal of Obstetrics & Gynecology.

As the most common pregnancy-associated hepatic disease in the U.S., occurring in 0.5% to 5% of pregnancies, intrahepatic cholestasis of pregnancy has been associated with preterm birth, nonreassuring fetal status, meconium-stained amniotic fluid and significantly increased stillbirth risk, according to study background.

“It is well established that intrahepatic cholestasis of pregnancy is associated with numerous complications, including a higher risk of stillbirth. Because of this risk, patients with this diagnosis receive extra fetal monitoring and are often delivered before their due date,” Miriam L. Estin, MD, PhD, maternal-fetal medicine physician in the department of obstetrics and gynecology at Duke University School of Medicine, told Healio. “Looking at a very large group of patients in the U.S., our study shows that managing intrahepatic cholestasis of pregnancy in this way successfully ameliorates the risk of stillbirth.”

Estin and colleagues conducted a retrospective cohort study of 9,987,705 delivery hospitalizations in the 2015-2020 National Readmissions Database. Researchers identified gestational age at delivery, occurrence of intrahepatic cholestasis of pregnancy and stillbirth, and comorbid conditions. They compared delivery timing and stillbirth rates for pregnant women with intrahepatic cholestasis of pregnancy and those without at the time of delivery hospitalization.

A total of 0.8% of births identified had an intrahepatic cholestasis of pregnancy diagnosis. Women with intrahepatic cholestasis of pregnancy were older (mean age, 29.3 years vs. 28.9 years; P < .001) and had a higher rate of gestational diabetes (11% vs. 7.9%; P < .001) compared with women without intrahepatic cholestasis of pregnancy.

Overall stillbirth rates were lower by 134 per 100,000 deliveries among women with intrahepatic cholestasis of pregnancy compared with women without (252 vs. 386 per 100,000 deliveries; P < .001). This result continued even after adjusting for insurance status, socioeconomic factors and comorbid conditions.

Women with intrahepatic cholestasis of pregnancy had a higher likelihood of delivering preterm compared with women without (30.1% vs. 9.3%; P < .001). However, women with intrahepatic cholestasis of pregnancy did not have increased stillbirth rates at any point following stratification by gestational age at delivery.

“We need to figure out how to identify the patients at highest risk for stillbirth in order to determine if it is safe to avoid early delivery in any subsets of patients with intrahepatic cholestasis of pregnancy,” Estin said.

For more information:

Miriam L. Estin, MD, PhD, can be reached at mle31@duke.edu.