Intrahepatic Cholestasis of Pregnancy and Fetomaternal Outcomes: A Retrospective Study from Uttarakhand, India

Background: Intrahepatic cholestasis of pregnancy (ICP) is a late pregnancy disorder marked by generalized itching, elevated liver enzymes, and spontaneous resolution after delivery.Its origins are multifaceted, and its impact on fetomaternal health is noteworthy.However, research on ICP remains limited, especially in Uttarakhand.Aim: This study endeavors to investigate the occurrence, connections, and pregnancy results associated with ICP.Methods: Between July 2020 and June 2022, this retrospective descriptive study was conducted at a tertiary healthcare center in Uttarakhand, India.The study included pregnant women diagnosed with ICP, who met the specified inclusion criteria.Maternal and neonatal data were extracted from medical records and analyzed using SPSS version 23.Results: The study revealed an ICP incidence of 4.3%.Participants aged 26-30 years accounted for 49.5% of the sample, with 50.5% being primigravida.Generalized itching without rashes emerged as the most common symptom.Pre-eclampsia affected 10.9% of participants, and gestational diabetes affected 9.8%.The average period of gestation at delivery was 37 1.2 weeks, with 36.9% of cases requiring induced labor.Cesarean section was performed in 33% of cases, and 22.3% exhibited meconium-stained liquor.Intrapartum fetal distress was observed in 13% of cases.Adverse neonatal outcomes included preterm birth (25.2%), low APGAR scores (7.2%), neonatal intensive care unit (NICU) admission (20.9%), and stillbirths (1.6%).Maternal serum bile acid levels showed a significant association with poor neonatal outcomes.Conclusion: Intrahepatic cholestasis of pregnancy carries increased risks of gestational diabetes mellitus and pre-eclampsia, along with higher rates of induction of labor and cesarean sections.Furthermore, it leads to adverse neonatal outcomes, strongly linked to levels of bile acids in the mother's serum. Clinical significance:The study highlights the significant association between levels of bile acids in the mother's serum and adverse neonatal outcomes.Monitoring maternal serum bile acid levels could predict poor neonatal outcomes and aid in the management of ICP-complicated pregnancies.