Earlier diagnosis of intrahepatic cholestasis of pregnancy and adverse pregnancy outcomes

Introduction We aimed to determine whether pregnancies complicated by early diagnosis of cholestasis were associated with adverse maternal or neonatal outcomes. Methods This is a retrospective cohort study of singleton, non‐anomalous live gestations complicated by cholestasis from 2005 to 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. Results Of 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 that 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). Conclusion Findings suggest that earlier diagnosis of cholestasis is associated with adverse outcomes and that this is not entirely driven by peak total bile acid levels.