Intrahepatic cholestasis of pregnancy and perinatal outcomes in twin pregnancies: a propensity score matching analysis

Intrahepatic cholestasis of pregnancy (ICP) tends to be more severe in twin pregnancies and is associated with adverse maternal and neonatal outcomes. However, data on the specific effects of ICP in twin gestations remain limited. This study aimed to investigate comprehensively the maternal and neonatal consequences of twin pregnancies complicated by ICP. This retrospective cohort study enrolled 3,109 twin pregnancies delivered at Northwest Women’s and Children’s Hospital in China from January 2018 through December 2022. Pregnancy and delivery data were extracted from the medical records of women with twin pregnancies who delivered at the hospital. Women were allocated into two groups: ICP (n = 244) and non-ICP (n = 2,865). ICP was diagnosed based on the presence of pruritus together with serum total bile acid (TBA) concentrations ≥10μmol/L. Propensity score matching (PSM) was used to balance baseline characteristics between the two groups. Multivariable logistic regression and generalized estimating equations (GEE) were applied to evaluate the associations between ICP and adverse maternal and neonatal outcomes. After matching, ICP increased the risk of maternal outcomes, including preterm labor (early preterm birth: OR = 2.87, 95% CI 1.95–4.23; preterm birth: OR = 4.30, 95% CI 2.11–8.77; very preterm birth: OR = 2.97, 95% CI 1.50–5.87) and hypoproteinemia (OR = 2.83, 95% CI 1.12–7.14), as well as adverse neonatal outcomes, including low birth weight (OR = 2.66, 95% CI 1.99–3.55), small vulnerable newborns (OR = 5.30, 95% CI 2.34–12.00), respiratory distress syndrome (OR = 2.43, 95% CI 1.61–3.67), and necrotizing enterocolitis (OR = 5.71, 95% CI 2.34–13.92). Twin pregnancies complicated by ICP were associated with increased risks of adverse perinatal outcomes, including preterm birth, low birth weight, and neonatal morbidity. These findings highlight the importance of heightened clinical awareness and individualized risk assessment in this high-risk population. In twin pregnancies, ICP is significantly associated with increased risks of preterm birth and hypoproteinemia after propensity score matching analysis. Neonates from twin pregnancies complicated by ICP have significantly higher risks of low birth weight, small vulnerable newborns, respiratory distress syndrome, and necrotizing enterocolitis. These findings highlight the importance of heightened clinical awareness and individualized risk assessment in twin pregnancies complicated by ICP.