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ORIGINAL RESEARCH article
Front. Med.
Sec. Obstetrics and Gynecology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1528705
Investigating the Risks of Late Preterm and Term Neonatal Morbidity Across Clinical Subtypes of Intrahepatic Cholestasis of Pregnancy
Provisionally accepted
Weizhen Tang 
Yi-Fan Zhao Lan Wang 
Qin-Yu Cai Wei-Ze Xu 
Li Wen Xue-Bing Chen Ting-He Sheng Tian-Qi Fan 
Tai-Hang Liu * Rong Li * Shang-Jing Liu - Chongqing Medical University, Chongqing, China
This investigation assesses the perinatal risks associated with different clinical subtypes of intrahepatic cholestasis of pregnancy (ICP) based on clinical symptomatology, with the goal of informing optimal delivery timing for each specific ICP subtype.The retrospective study encompassed 2,057 singleton pregnancies with ICP, categorized into single-symptomatic (ICP-S) and multi-symptomatic (ICP-M) groups.The ICP-M group was further subdivided based on symptom combinations: elevated TBA with elevated transaminases (ICP-MT), elevated TBA with pruritus (ICP-MP), and combined elevations with pruritus (ICP-MB). The investigation included an assessment of baseline characteristics, comparison of perinatal outcomes between ICP-S and ICP-M, evaluation of the impact of ursodeoxycholic acid and second-line treatments, and analysis of severe adverse neonatal outcomes by clinical classification and gestational age through logistic regression and restricted cubic spline methods.Baseline characteristics suggested in vitro fertilization (IVF) and Nullipara as more prevalent in ICP-M, which also had an earlier diagnosis of ICP compared to ICP-S.Additionally, ICP-M exhibited higher liver function and blood glucose levels. ICP-M was significantly associated with increased risks of gestational diabetes mellitus (GDM) (OR 1.57), preterm birth (OR 1.92), low birth weight infant (OR 1.81), and neonatal intensive care unit (NICU) admissions (OR 1.48) compared to ICP-S.Among ICP-M subgroups, ICP-Mp exhibited the highest risk of adverse outcomes. Ursodeoxycholic acid (UDCA) treatment was found to be beneficial in reducing the risk of preterm birth, particularly in ICP-M. The study also highlighted that late preterm or post-term delivery in ICP-M patients exacerbates NICU risk.Women with ICP-M experience elevated perinatal risks, including a higher risk of coexisting GDM, as well as increased risks of preterm birth and NICU admissions.Personalized clinical management, optimizing delivery timing based on clinical subtypes, and providing UDCA to improve neonatal outcomes during pregnancy are important measures worthy of attention.
Keywords: Intrahepatic cholestasis of pregnancy, Pregnancy Outcome, Subtype of ICP, neonatal intensive care unit, Ursodeoxycholic Acid
Received: 15 Nov 2024; Accepted: 27 Feb 2025.
Copyright: © 2025 Tang, Zhao, Wang, Cai, Xu, Wen, Chen, Sheng, Fan, Liu, Li and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Tai-Hang Liu, Chongqing Medical University, Chongqing, China
Rong Li, Chongqing Medical University, Chongqing, China
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