Abstract
INTRODUCTION: We aimed to determine whether pregnancies complicated by early diagnosis of cholestasis were associated with adverse maternal or neonatal outcomes. METHODS: This is a retrospective cohort study of singleton, non-anomalous live gestations complicated by cholestasis from 2005-2019. We compared rates of adverse outcomes in pregnancies complicated by early (<32-week gestational age) versus late (≥ 32-week gestational age) diagnosis of cholestasis. Our primary outcome of interest was rates of spontaneous preterm birth. Secondary outcomes included rates of iatrogenic preterm birth, meconium-stained amniotic fluid, cesarean delivery for non-reassuring fetal heart tracing, and neonatal intensive care unit admission. RESULTS: Of the 1247 pregnancies complicated by cholestasis, 241 (19.3%) had early diagnosis and 1006 (80.7%) had late diagnosis. After adjusting for confounders including peak total bile acid levels, earlier diagnosis of cholestasis remained associated with spontaneous preterm birth (OR 1.81; 95% CI 1.11-2.95), iatrogenic preterm birth, (OR 1.59; 95% CI 1.12-2.67), and NICU admission (OR 1.43; 95% CI 1.04-1.95). A sub-analysis to compare outcomes with severe cholestasis (peak total bile acids ≥ 40 μmol/L) showed early diagnosis of severe cholestasis was also associated with spontaneous preterm labor (OR 2.41; 95% CI 1.34-4.34), iatrogenic preterm birth, (OR 1.67; 95% CI 1.05-2.67), and NICU admission (OR 1.66; 95% CI 1.06-2.61). CONCLUSION: Findings suggests that earlier diagnosis of cholestasis is associated with adverse outcomes and that this is not entirely driven by peak total bile acid levels.