Influence of severity of total bile acids and mode of delivery on the perinatal outcomes in intrahepatic cholestasis of pregnancy

To assess the associations between mode of delivery and pregnancy outcomes in patients with intrahepatic cholestasis of pregnancy (ICP) based on the severity of maternal hypercholanemia. A hospital-based retrospective cohort study was performed between January 1, 2015, and December 31, 2019. Among the 177 women with mild total bile acids, 123 (69.5%) had a vaginal delivery and 54 (30.5%) underwent a cesarean delivery, of which 42 (23.7%) were planned and 12 (6.8%) were unplanned. Among the 50 severe ICP women, 13 (26.0%) had a vaginal delivery and 37 (74.0%) underwent a cesarean delivery, of which 26 (52.0%) were planned and 11 (22.0%) were unplanned. Severe ICP was associated with an increased risk of preterm delivery ( P  < 0.001), low birthweight ( P =0.001), and neonatal intensive care unit admission ( P  < 0.001). Women with severe ICP (aOR, 5.017; 95% CI 1.848–13.622), planned cesarean delivery (aOR, 5.444; 95%CI 1.723–17.203), or unplanned cesarean delivery (aOR, 5.792; 95%CI 1.384–24.236) had increased risks of adverse fetal outcomes compared to controls. Both planned and unplanned cesarean delivery are associated with a higher incidence of adverse fetal outcomes and severe ICP than vaginal delivery.