Twin pregnancy with intrahepatic cholestasis of pregnancy face more severe adverse pregnancy outcomes

Abstract:

Objective To investigate the adverse pregnancy outcomes of pregnant women with a singleton or twin pregnancy diagnosed with intrahepatic cholestasis of pregnancy（ICP）.Methods Clinical data were collected from 2886 pregnant women with ICP who delivered in The First Affiliated Hospital of Chongqing Medical University from 2018 to 2021，and based on the inclusion and exclusion criteria，1992 cases were selected for subsequent analysis. The pregnant women with ICP were divided into singleton pregnancy group and twin pregnancy group based on the number of fetuses delivered. Baseline characteristics were analyzed for both groups，and propensity score matching（PSM） was used to adjust any baseline differences between the two groups. The chi-square test was used to analyze the adverse pregnancy outcomes of pregnant women with ICP.Results Before PSM，there were significant differences between the two groups in all baseline characteristics except pre-pregnancy body weight（P=0.064） and smoking（P=0.129），while there were no significant differences between the two groups after PSM. As for maternal outcomes，compared with the singleton ICP group，the twin ICP group had significantly higher incidence rates of gestational hypertension（8.40%；P=0.004），preeclampsia（10.9%；P=0.035），placenta accreta spectrum（15.1%；P=0.004），and polyhydramnios（5.30%；P=0.010）； compared with the twin ICP group，the singleton ICP group had significantly higher incidence rates of preterm rupture of membranes（27.0%；P=0.002） and oligohydramnios（12.3%；P=0.022）. In terms of neonatal outcomes，compared with the singleton ICP group，the twin ICP group had significantly higher incidence rates of preterm birth（38.9%；P<0.001），fetal anomaly（3.90%；P=0.004），low birth weight（44.6%；P<0.001），and admission to the neonatal intensive care unit（24.91%；P<0.001）；compared with the twin ICP group，the singleton ICP group had a significantly higher incidence rate of fetal macrosomia（4.91%；P=0.007）.Conclusion Compared with the pregnant women with ICP and a singleton pregnancy，the pregnant women with ICP and twin pregnancy tend to face more severe adverse pregnancy outcomes.