Evaluating the 2023 European Association for the Study of the Liver Guidelines for Intrahepatic Cholestasis of Pregnancy: Risk Stratification and Outcomes in Over 4,000 US Patients

Our systematic evaluation of the 2023 European Association for the Study of the Liver guidelines for suspected ICP demonstrated that this novel group-based classification offers clinically meaningful risk stratification. Our findings support that both elevated TSBA (Group C) and elevated ALT/AST alone (Group B) warrant antepartum surveillance for adverse pregnancy outcomes. Group C's association with Hispanic ethnicity and pre-existing liver disease highlights the need for individualized monitoring during pregnancy. Group-specific increased incidence of postpregnancy hepatobiliary disease emphasizes the importance of targeted postpartum follow-up.