Intrahepatic cholestasis of pregnancy (ICP) is a liver condition during pregnancy that presents as itchy skin and elevated bile acid levels. Bile acids can cross the placenta, which has been linked to adverse fetal and perinatal outcomes.1 The longer-term neurodevelopmental implications for offspring are less well characterized.
We studied 42,144 children born between January 1, 2010, and December 31, 2020, with follow-up through at least their fifth birthday. Children were included if they had a documented gestational age, a link to their mother’s chart, at least one outpatient face-to-face encounter at least every 18 months from birth through age 4.5, and at least one visit after age 5. We excluded children with neonatal abstinence syndrome or genetic abnormalities. We matched each child born to a mother with ICP to four children who were not exposed based on race, ethnicity, infant sex, delivery method, and whether they were diagnosed as small for their gestational age. We additionally accounted for prematurity, maternal age, multiple gestation, maternal comorbidities, social vulnerability, birth weight, and APGAR scores.
Motor delays and pervasive developmental delays were diagnosed in fewer than 4% of all children in the study. Speech and language delays were more common, with nearly 20% of all children studied having a speech or language delay diagnosis.
Compared with children who were not born to mothers diagnosed with ICP, those born to mothers diagnosed with ICP were 31% more likely to have a motor delay, 28% more likely to have a pervasive developmental disorder, and 19% more likely to have a speech or language delay by age 5.
