Recurrent intrahepatic cholestasis of pregnancy incidence and risk factors: A retrospective cohort study

The incidence of intrahepatic cholestasis of pregnancy (ICP) varies throughout the world and is influenced by genetic, hormonal, and environmental factors. However, data are limited regarding the risk of ICP recurrence in subsequent pregnancies. We aimed to determine the incidence of recurrent ICP and its associated risk factors.

A retrospective cohort study conducted at a university hospital during 2007-2023, including all pregnant individuals who underwent serum bile acids (BA) level testing due to suspected ICP. Among those diagnosed with ICP, records were reviewed to identify those with a subsequent gestation.

Of 640 individuals who met the inclusion criteria, 22.2% (n = 142) were diagnosed with ICP (fasting serum BA > 10 µmol/L) in the index pregnancy. Of them, 51 (35.9%) had a subsequent pregnancy. The rate of recurrent ICP in the subsequent pregnancy was 29.4% (15/51). Timing of ICP diagnosis did not differ significantly between the index and subsequent gestation (median 33 [IQR 30-36] vs. 34 [IQR 31-35] weeks, p = 0.90). In multivariable analysis, serum BA levels at the index pregnancy above 40 µmol/L were the only independent factor associated with ICP recurrence.

Recurrence of ICP is common, occurring in over one-fourth of patients with a history of ICP. BA levels at the first pregnancy in which ICP was diagnosed were found as the only independent factor associated with the occurrence of ICP in subsequent gestation.