Outcomes of subsequent pregnancy following intrahepatic cholestasis of pregnancy: A retrospective cohort study

OBJECTIVE: Data on subsequent pregnancies after intrahepatic cholestasis of pregnancy (IHCP) are limited. We aimed to determine IHCP recurrence, identify risk factors, and describe outcomes in subsequent pregnancies. METHODS: This retrospective study at a tertiary center (2012-2024) included individuals with prior IHCP. Multiple gestations and those without a documented subsequent pregnancy were excluded. We assessed recurrence, maternal and neonatal outcomes, and compared characteristics between those with recurrent IHCP (rIHCP) and those without. Multivariable regression estimated odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Among 142 087 deliveries, 1094 (0.8%) were diagnosed with IHCP, and 874 (80%) were singleton pregnancies. Of these, 264 (30.2%) had a subsequent pregnancy. IHCP recurred in 93/264 (35.2%). Individuals with rIHCP were younger (28 vs. 30.6 years, P < 0.01), more likely to undergo labor induction (79.6% vs. 66.7%, P = 0.02), and less likely to have cesarean delivery (7.5% vs. 22.2%, P < 0.01). Assisted reproductive techniques (ART) in the index pregnancy was associated with reduced recurrence (OR 0.3, 95% CI: 0.1-0.9), whereas earlier IHCP onset (35.1 vs. 35.5 weeks, OR 0.9, 95% CI: 0.8-0.9) and elevated liver enzymes (75.3% vs. 58.5%, OR 2.5, 95% CI: 1.4-4.6) increased recurrence risk. In subsequent pregnancies, rIHCP was associated with earlier delivery (37.3 vs. 39 weeks, P < 0.01), more labor induction (63.4% vs. 29.8%, P < 0.01), and lower cesarean rates (14% vs. 24.6%, P = 0.04). CONCLUSION: Approximately one-third of individuals with IHCP experience recurrence. Earlier onset, elevated liver enzymes, and lower ART use in the index pregnancy predict recurrence, providing critical information for counseling, clinical management, and future guideline development.