Intrahepatic cholestasis of pregnancy (ICP), the most prevalent pregnancy-related liver disease, is associated with higher rates of maternal, fetal, and newborn complications, according to a recent systematic review and meta-analysis.
The review, published in the Journal of Midwifery & Women’s Health, pooled data from ten studies conducted across various countries, including China, France, India, the Netherlands, and Turkey. It found that ICP, characterized by a stalled flow of bile in the liver, significantly impacts pregnancy outcomes. The overall frequency of ICP was found to be 1.7%.
Pregnant women with ICP faced notably higher risks of several adverse outcomes. The study revealed that these women had a threefold higher chance of experiencing maternal infections and pregnancy-related high blood pressure disorders. They were also nearly three times more likely to undergo a Cesarean section compared to those without ICP. However, no significant differences were observed in terms of induced labor, pregnancy-related diabetes, postpartum bleeding, or abnormal amounts of amniotic fluid.
The researchers emphasize the need for increased monitoring and specialized care for pregnant individuals with ICP. They suggest enhancing pregnancy follow-up, coordinating with tertiary health care institutions, and ensuring delivery in facilities equipped with neonatal intensive care units (NICUs).
ICP also adversely affects fetal and newborn health. The study found that babies born to mothers with ICP were four times more likely to experience preterm birth and were over twice as likely to be admitted to the NICU. These newborns were also more prone to having low birth weight and being smaller than expected for their gestational age.
Despite these challenges, the study noted that the risk of perinatal death (death between 28 weeks of gestation and the first seven days of life) was lower in the ICP group. This may be attributed to the selection of studies focusing on low-risk pregnancies.
No significant differences were found between the ICP and non-ICP groups concerning abnormal fetal heart rate, the presence of meconium in the amniotic fluid, or a low Apgar score at five minutes after birth, indicating stable initial health assessments despite ICP.
The review underscores the importance of educating healthcare professionals about ICP and its potential adverse outcomes. The researchers advocate for incorporating early diagnosis and management of ICP into pre- and post-licensure training programs.
Probiotics such as Bifidobacterium breve have been suggested as potential interventions for ICP, but their efficacy and safety are still under investigation. The researchers call for further high-quality research to explore the genetic, hormonal, and environmental factors influencing ICP and to better understand its impact on pregnancy outcomes.
“Given the complex nature of ICP, including its development and geographic variations, more comprehensive research is essential to address these issues effectively,” the researchers concluded.
