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Evaluating the 2023 EASL guidelines for intrahepatic cholestasis of pregnancy: risk stratification and outcomes in over 4,000 U S patients #MMPMID41351236
Am J Gastroenterol 2025[Nov]; ? (?): ? PMID41351236show ga
INTRODUCTION: Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disease of pregnancy, varying in incidence based on population and associated with adverse outcomes. We assessed the prevalence and outcomes of ICP categories defined by the 2023 EASL guidelines in a diverse U.S. population. METHODS: We conducted a retrospective cohort study (January 2009-April 2024) at our ethnically diverse health system. Suspected ICP patients were identified by pregnancy records with total serum bile acids (TSBA) ordered and categorized into Group A (normal TSBA, ALT/AST), B (elevated ALT/AST, normal TSBA), or C (TSBA>19, normal or elevated ALT/AST). RESULTS: Among 165,503 pregnancies, we identified 4,386 (3.6%) suspected ICP cases. The cohort was classified as A (65%), B (24%), or C (11%). On multivariable analysis, a pre-existing history of autoimmune disease, MASLD, and gestational hypertension were significantly associated with Group B compared to A. Group C was more strongly associated with Hispanic ethnicity, history of hepatitis C, and immune-mediated liver diseases. Preeclampsia was three times as common in Groups B and C compared to A. Group C had the highest odds of spontaneous preterm birth, meconium-stained amniotic fluid, and neonatal respiratory distress. Group B and C had higher rates of incident postpartum hepatobiliary diseases. CONCLUSION: Our systematic evaluation of the 2023 EASL guidelines for suspected ICP demonstrated that this novel group-based classification offers clinically meaningful risk stratification. Our findings support that both elevated TSBA (Group C) and elevated ALT/AST alone (Group B) warrant antepartum surveillance for adverse pregnancy outcomes. Group C's association with Hispanic ethnicity and pre-existing liver disease highlights the need for individualized monitoring during pregnancy. Group-specific increased incidence of post-pregnancy hepatobiliary disease emphasizes the importance of targeted postpartum follow-up.
Am+J+Gastroenterol 2025 ; ? (?): ?
