The Impact of Assisted Reproductive Technology in Twin Pregnancies Complicated by Intrahepatic Cholestasis of Pregnancy: a Retrospective Cohort Study

Abstract

Introduction Our study aims to evaluate the perinatal outcomes in twin pregnancies diagnosed with intrahepatic cholestasis of pregnancy (ICP) and to compare these with normal healthy twin pregnancies for perinatal outcomes. The second outcome of the study was to determine whether in vitro fertilization-embryo transfer (IVF-ET) affects the perinatal outcome in ICP patients.

Materials and Methods In this study, 59 ICP and 641 healthy twin pregnancies were compared for perinatal outcomes retrospectively. According to the mode of conception, the twin pregnancies with ICP were divided into 2 groups. The twin pregnancies with ICP who were conceived with IVF were referred to as the IVF-ET group. The twin pregnancies with ICP who were conceived spontaneously or by ovulation induction and intrauterine insemination (IUI) were referred to as the non-IVF-ET group.

Results Twin pregnancies with ICP give birth significantly earlier than normal twin pregnancies (p ˂ 0.001). The diagnosis of ICP occurred significantly earlier in the IVF-ET pregnancy with ICP than in the non-IVF-ET group. In twin pregnancies with IVF-ET, patients delivered significantly earlier than in the non-IVF-ET group (p=0.002). Twin pregnancies with ICP were found to have significantly higher rates of meconium-stained amniotic fluid, postnatal intubation, and admission to the neonatal intensive care unit (NICU) than healthy twin pregnancies.

Conclusions ICP is a risk factor for preterm delivery in twin pregnancies. In addition, ICP develops earlier and more frequently in twin pregnancies from IVF-ET than in those from non-IVF twin pregnancies, and the disease may be more serious.

Keywords

Intrahepatic Cholestasis of Pregnancy - Twin Pregnancy - In-Vitro Fertilization- Embryo Transfer

• References

• 1 Geenes V, Williamson C. Intrahepatic cholestasis of pregnancy. World J Gastroenterol 2009; 15: 2049-2066
• 2 Liu S, Li L, Liu H. Clinical analysis of 57 cases of intrahepatic cholestasis of pregnancy with twins. Sichuan Med 2010; 12: 1814-1815
• 3 Pacella G, Salsi G, Arcangeli T. et al. The impact of assisted reproductive technology and chorionicity in twin pregnancies complicated by obstetric cholestasis. J Matern Fetal Neontal Med 2015; 6: 1-5
• 4 Germain AM, Carvajal JA, Glasinovic JC. Intrahepatic cholestasis of pregnancy: an intriguing pregnancy-specific disorder. J Soc Gynecol Investig 2002; 9: 10-14
• 5 Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: relationships between bile acid levels and fetal complication rates. Hepatology 2004; 40: 467-474
• 6 Geenes V, Chappell LC, Seed PT. et al. Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: a prospective population based case-control study. Hepatology 2014; 59: 1482-1489
• 7 Brouwers L, Koster MP, Page-Christiaens GC. et al. Intrahepatic cholestasis of pregnancy: maternal and fetal outcomes associated with elevated bile acid levels. Am J Obstet Gynecol 2015; 212: 1-7
• 8 Yang H, Hu M, Chen J. Maternal and fetal outcomes of women with intrahepatic cholestasis of pregnancy. Chin J Obstet Gynecol 2016; 51: 535-537
• 9 Çelik S, Soyer Çalışkan C, Çelik H. et al. Predictors of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy. Ginekol Pol 2019; 90: 217-222
• 10 Cui D, Zhong Y, Zhang L. et al. Bile acid levels and risk of adverse perinatal outcomesin intrahepatic cholestasis of pregnancy: a meta-analysis. J Obstet Gynecol Res 2017; 43: 1411-1420
• 11 Herrera CA, Manuck TA, Stoddard GJ. et al. Perinatal outcomes associated with intrahepatic cholestasis of pregnancy. J Mat Fet Neonat Med 2018; 31: 1913-1920
• 12 Liu X, Landon MB, Chen Y. et al. Perinatal outcomes with intrahepatic cholestasis of pregnancy in twin pregnancies. J Mat Fet Neonat Med 2016; 29: 2176-2181
• 13 Mei Y, Gao L, Lin Y. et al. Perinatal outcomes in intrahepatic cholestasis of pregnancy with monochorionic diamniotic twin pregnancy. BMC Pregnancy Childbirth 2018; 18: 291
• 14 Koivurova S, Hartikainen AL, Karinen L. et al. The course of pregnancy and delivery and the use of maternal healthcare services after standard IVF in Northern Finland 1990–1995. Human Reprod 2002; 17: 2897
• 15 Feng C, Li WJ, He RJ. et al. Impacts of different methods of conception on the perinatal outcome of intrahepatic cholestasis of pregnancy in twin pregnancies. Sci Rep 2018; 8: 3985