Clinical outcomes of intrahepatic cholestasis of pregnancy with versus without chronic hepatitis B: A retrospective analysis.

BACKGROUND

Intrahepatic cholestasis of pregnancy (ICP) is a multifactorial liver disorder associated with adverse pregnancy outcomes. Chronic hepatitis B (CHB) has been reported with increased risk of ICP, while the clinical characteristics and outcomes of isolated ICP compared with ICP involving CHB remain poorly understood.

METHODS

ICP involving CHB was defined as the co-concurrence of ICP with CHB, categorized into immune-tolerant CHB (n=44), inactive CHB (n=86), immune-active CHB (n=127), and grey zone CHB (n=89). Isolated ICP (n=826) was defined as ICP without viral hepatitis, while immune-active CHB with normal elevated total bile acid (TBA) (n=87) serves as controls.

RESULTS

Women with ICP involving immune-active CHB experienced the most severe biochemical abnormalities and adverse outcomes, whereas other CHB subgroups exhibited biochemical profiles and outcomes comparable to isolated ICP cases. Assisted reproductive technology (aOR, 1.24), TBA levels (40-99.9 µmol/L-aOR, 1.27, ≥100 µmol/L-aOR, 1.60), and immune-active CHB (aOR, 1.12) were associated with increased risks of composite adverse outcomes. Stratified analysis revealed that TBA ≥40 µmol/L significantly correlated with increased risks of total and iatrogenic preterm birth and neonatal intensive care unit admission (p<0.05); while TBA ≥100 µmol/L was further associated with elevated risks of meconium-stained amniotic fluid and lower Apgar scores (p<0.05). Immune-active CHB women with normal TBA demonstrated relatively higher levels of transaminase but achieved the most favorable pregnancy outcomes.

CONCLUSIONS

ICP involving immune-active CHB demonstrated the most severe biochemical abnormalities and adverse pregnancy outcomes, while ICP involving other CHB immune phases showed transient mild biochemical changes and outcomes comparable to isolated ICP. The findings underscore the need to tailor diagnostic, monitoring, and management strategies based on TBA levels and the immune status of CHB.