(499) The risk of ICP recurrence in the subsequent pregnancy: a retrospective analysis

Objective: The recurrence risk of intrahepatic cholestasis of pregnancy (ICP) has been reported to be between 40-90% based on small studies with homogeneous populations. Our aim was to determine the recurrence risk of ICP and identify variables associated with recurrence in a larger, more diverse population.

Study Design: Retrospective cohort study of singleton, non-anomalous gestations complicated by ICP at a single academic center between 2015-2024. The EMR was used to identify patients with a first delivery complicated by ICP (initial) and a subsequent pregnancy with or without ICP (subsequent), both delivering at the same institution. The primary outcome was the recurrence of ICP in the subsequent pregnancy; secondary outcomes include identifying variables associated with ICP recurrence. Univariable and multivariable logistic regression were used to calculate the odds ratio and 95% confidence interval (OR [95% CI]) adjusting for advanced maternal age, history of hepatobiliary disease, and gestational diabetes.

Results: A total of 104 patients with ICP were identified, 46 (44%) of whom developed ICP in the subsequent pregnancy [Table 1]. In the group that had recurrent ICP, more patients self-identified as Hispanic (84.8% vs. 65.5%), but there were no differences in age or comorbidities in the initial pregnancy. The recurrent group had more patients with peak total bile acids (TBA) >40 (31. % vs. 7.6%, p=0.01) and alkaline phosphatase (ALP) twice the upper limit of normal (37.0% vs. 19.0%, p=0.04) in the initial pregnancy [Table 1]. In a multivariable regression, index pregnancy peak TBA >40 was associated with recurrence (aOR 6.03 Cl 1.81-20.07) and short-interval pregnancy was associated with decreased recurrence (aOR 0.40 Cl 0.17-0.96) [Table 2].

Conclusion: In this ICP cohort, the risk of recurrence in the subsequent pregnancy was 44%. Only peak TBA >40 in the initial pregnancy was associated with recurrence. Given the wide range of reported ICP recurrence rates in the literature, larger studies are warranted to improve pre-conception counseling.