Early versus Late Onset Intrahepatic Cholestasis of Pregnancy: A Prospective Observational Study

Abstract

Background: Intrahepatic cholestasis of pregnancy (ICP) represents a pregnancy-specific hepatobiliary disorder characterized by pruritus and elevated serum bile acids. The gestational age at onset may influence disease severity and pregnancy outcomes, necessitating comparative evaluation of early and late presentations.
Methods: A prospective observational study was conducted over 18 months at a tertiary care center. Eighty pregnant women diagnosed with ICP were categorized into early-onset (diagnosis <32 weeks gestation, n=30) and late-onset (diagnosis ≥32 weeks gestation, n=50) groups. Maternal demographic characteristics, biochemical profiles including serum bile acids and liver enzymes, and comprehensive perinatal outcomes were systematically documented and compared. All participants received ursodeoxycholic acid therapy with weekly monitoring until delivery.
Results: Early-onset ICP demonstrated significantly elevated mean serum bile acid concentrations (46.8±12.4 µmol/L versus 24.6±8.2 µmol/L, p<0.001) and higher aminotransferase levels compared to late-onset disease. Perinatal complications were substantially increased in the early-onset group, including preterm delivery (46.6% versus 18.0%, p=0.006), meconium-stained amniotic fluid (36.6% versus 14.0%, p=0.019), and neonatal intensive care unit admissions (33.3% versus 12.0%, p=0.021). No stillbirths occurred in either group. Both groups demonstrated symptomatic improvement with pharmacological intervention.
Conclusion: Early-onset intrahepatic cholestasis of pregnancy is associated with more severe biochemical derangement and significantly increased adverse perinatal outcomes. These findings emphasize the necessity for enhanced fetal surveillance, earlier intervention, and individualized obstetric management in women presenting with ICP before 32 weeks gestation.