PREVALENCE OF INTRAHEPATIC CHOLESTASIS OF PREGNANCY AMONG PREGNANT WOMEN WITH GESTATIONAL DIABETES MELLITUS: A CROSS-SECTIONAL STUDY

Abstract

Background: Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific cholestatic disorder characterized principally by pruritus and elevated maternal serum bile acids. Gestational diabetes mellitus (GDM) is common and has been reported to coexist with ICP. Objective: To determine the prevalence of ICP among pregnant women with GDM presenting to Memon Medical Institute Hospital, Karachi. Methods: A descriptive cross-sectional study was conducted from 20 December 2022 to 20 June 2023. A total of 276 pregnant women aged 19–40 years, at ≥24 weeks of gestation, with GDM diagnosed using a 75-g oral glucose tolerance test according to ADA/IADPSG thresholds were enrolled by consecutive sampling. ICP was operationally defined as serum bile acids ≥10 µmol/L, at least two-fold elevation of AST and ALT, negative viral hepatitis serology, and normal abdominal ultrasonography. Associations with selected maternal characteristics were assessed using chi-square or Fisher’s exact tests. Results: Among 276 women with GDM, 22 had ICP, giving a prevalence of 8.0% (95% CI 5.3%–11.8%). Mean age was 31.40 ± 5.37 years, mean gestational age 26.28 ± 1.50 weeks, mean BMI 25.47 ± 2.04 kg/m², and mean serum bile acid level 6.65 ± 4.59 µmol/L. Previous ICP was reported by 29 (10.5%) women. ICP prevalence was higher among women with family income <100,000 PKR/month (10.3% vs 0%; p=0.003), BMI <23 kg/m² (21.2% vs 3.8%; p<0.001), multiparity (12.7% vs 0.9%; p<0.001), and previous ICP (48.3% vs 3.2%; p<0.001). Age, gestational age, and residence were not significantly associated with ICP. Conclusion: ICP occurred in 8% of pregnant women with GDM in this tertiary-care cohort. A previous history of ICP showed the strongest observed association with ICP in the current pregnancy.