(689) Recurrent Intrahepatic Cholestasis of Pregnancy- Incidence and Risk factors

Objective: The incidence of intrahepatic cholestasis of pregnancy (ICP) varies throughout the world and is influenced by genetic, hormonal and environmental factors. However, data is highly limited regarding the risk of ICP recurrence in subsequent pregnancies. We aimed to incidence of recurrent ICP and its associated risk factors.

Study Design: A retrospective cohort study conducted at a university hospital, including all pregnant women who underwent serum bile acids (BA) levels testing due to suspected ICP in a 13-year period. Among women diagnosed with ICP, records were reviewed to identify those with a subsequent gestation.

Results: Of 640 women who met the inclusion criteria, 22.2% (n=142) were diagnosed with ICP (fasting serum BA >10 mmol/L) in the index pregnancy. Of them, 51 (35.9%) had a subsequent pregnancy. The rate of recurrent ICP in the subsequent pregnancy was 29.4% (15/51). Timing of ICP diagnosis did not differ significantly between the index and subsequent gestation (median 33 [IQR 30-36] vs. 34 [IQR 31-35] weeks, P=0.90). In multivariable analysis, fasting serum BA levels at the index pregnancy above 40 mmol/L was the only independent factor associated with ICP recurrence.

Conclusion: Recurrence of ICP is common, occurring in over one fourth of women with a history of ICP. BA levels at the first pregnancy in which ICP was diagnosed were found as the only independent factor associated with the occurrence of ICP in subsequent gestation.