Intrahepatic cholestasis of pregnancy is associated with increased risk of hepatobiliary disease and adverse fetal outcomes: A systematic review and meta-analysis

Background and aims:The aim of this study was to review the literature and perform a meta-analysis to clarify the association between intrahepatic cholestasis of pregnancy and risks of long-term maternal hepatobiliary disease as well as adverse fetal outcomes including preterm birth,meconium-stained amniotic fluid,and stillbirth.Methods:This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.A comprehensive literature search was performed using Cochrane,Embase,and PubMed databases to identify observational or cohort studies comparing pregnant women with intrahepatic cholestasis of pregnancy(ICP)to pregnant women without ICP.Data from the included studies were analyzed using the Review Manager 5.4.1 software.Results:The meta-analysis showed a significant association between ICP and the risk of hepatobiliary diseases(pooled risk ratio[RR]:2.81,95%confidence interval[CI]:2.66–2.97,p<0.00001),hepatitis C(HC):a significant association between ICP and risk of HC(pooled RR:4.02,95%CI:3.12–5.19,p<0.00001),meconium-stained amniotic fluid(MSAF):ICP was significantly associated with an increased risk of MSAF(pooled RR:1.91,95%CI:1.65–2.21,p<0.00001),and preterm birth:the meta-analysis demonstrated a significant association between ICP and preterm birth(pooled RR:2.11,95%CI:2.01–2.21,p<0.00001).Conclusion:ICP demonstrated statistically significant associations with increased risks of hepatobiliary disease,HC,MSAF,and preterm birth.