Comparison of composite adverse perinatal outcomes in early- and late-onset intrahepatic cholestasis of pregnancy.

Aim: To compare composite adverse perinatal outcomes (CAPO) in women with early- and late-onset intrahepatic cholestasis of pregnancy (ICP). Materials and Methods: This study was designed as a single-center, retrospective study in a tertiary hospital and included a total of 198 patients with ICP, including 36 patients with early-onset ICP (EO-ICP) and 162 patients with late-onset ICP (LO-ICP). ICP that developed before the 28thweek of gestation was defined as EO-ICP, and ICP that occurred after the 28thweek of gestationwas defined as LO-ICP. The existence of at least one of the following criteria was defined as CAPO: umbilical cord arterial pH < 7.20, fifth-minute Apgar score < 5, andneonatal intensivecarestay of>24 hours. Results:The rates of spontaneous preterm birth and neonatal intensive care admission were statistically significantly higher in the EO-ICP group (p<0.001). In the same group, a significantly higher number of neonates were born with meconium (p=0.040). The use of ursodeoxycholic acid was significantly greater in the EO-ICP group (p=0.007). The two groups did not show any significant differences in terms of neonatal umbilical cord arterial pH or base excess (p>0.05), however, the CAPO rate was significantly higher in the EOICP group(p=0.028). Receiver operator characteristic analysis revealed an optimal cut-off value of 33.5 μmol/L for the serum bile acid level, at which this parameter had 74% sensitivity and 68% specificity (area under the curve=0.759; p<0.001) in the prediction of CAPO. Conclusion: We consider that the high CAPO rates in the fetuses of patients with EO-ICP are due to the effect of high serum bile acid levels on the fetus for a longer time than in the LO-ICP group. The differentiation of cases of EO-ICP and LO-ICP will serve as a guide for clinicians in predicting possible complications. [ABSTRACT FROM AUTHOR]