Perinatal Outcomes of Monochorionic and Dichorionic Twin Pregnancies Complicated by Intrahepatic Cholestasis of Pregnancy: A 6-year Retrospective Cohort Study

Abstract

Abstract Introduction Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy-related liver disorder and may cause adverse perinatal outcomes. However, few studies have reported differences in perinatal outcomes of monochorionic and dichorionic twin pregnancies complicated by ICP. These perinatal outcomes were assessed with a retrospective cohort study. Methods This was a retrospective observational study of monochorionic and dichorionic twin pregnan-cies complicated by ICP. Cases were divided into the MCDA group and DCDA group, perinatal outcomes were compared, and predictors of adverse perinatal outcomes were evaluated. Results In total, 363 twin pregnancies complicated by ICP (93 monochorionic (MC), 270 dichorionic (DC)) were included. Compared with DC twin pregnancies, MC pregnancies were characterized by younger age, lower prepregnancy weight and lower prepregnancy body mass index (p<0.05). Delivery of MC twins was more likely to occur between 34 and 37 weeks, averaging 34.87±2.42 gestational weeks. Additionally, both twins A and B in the MC group weighed less than those in the DC group (p<0.001). After adjustment for confounders, TBA>40 µmol/l (aOR=9.16, 95%CI:1.06, 30.93, p=0.029) was an independent risk factor for poor perinatal outcomes in MC twin pregnancies complicated by ICP, and TBIL>17.1 µmol/l (aOR=6.36, 95% CI: 1.63-24.92, p=0.008), AST>200 U/L (aOR=3.005, 95%CI: 1.32-6.87, p=0.009) and ALP>400 U/L (aOR=3.25, 95%CI: 1.12-9.45, p=0.031) were independent risk factors for adverse perinatal outcomes in DC twin pregnancies. Conclusions Our results suggest that some liver function biochemical indicators can predict poor foetal outcomes in twin pregnancies complicated by ICP. More focus is needed on the monitoring of predelivery liver functional biochemical indexes in pregnant women according to chorionicity complicated by ICP, to facilitate personalized antenatal management and improve neonatal outcomes.