title: Perinatal outcomes with intrahepatic cholestasis of pregnancy in twin pregnancies.
abstract: OBJECTIVE
  To describe perinatal outcomes of twin pregnancies complicated by intrahepatic cholestasis of pregnancy (ICP).
  
  
  METHODS
  We conducted a retrospective cohort study of women delivered at a large tertiary obstetric center in Shanghai, China from January 2006 to May 2014. Delivery data were abstracted from medical records of all twin gestations delivered at the hospital.
  
  
  RESULTS
  A total of 129/1922(6.7%) twin and 1190/92 273 singleton (1.3%) pregnancies were complicated by ICP. An increased risk of stillbirth among twin pregnancies was observed (3.9% and 0.8% in the ICP and non-ICP groups, respectively; aOR 5.75, 95% CI 2.00-16.6). Stillbirths with ICP and twins occurred between 33 and 35 weeks gestation compared to 36-38 weeks gestation among singletons. ICP in twins was also associated with an increased risk of preterm birth (<37 weeks) with an aOR of 4.17 (95% CI 2.47-7.04) and an aOR of 1.89 (95% CI 1.26-2.85) for delivery <35 weeks. Twin pregnancies complicated by ICP also had increased meconium staining of amniotic fluid and lower birth weight.
  
  
  CONCLUSIONS
  Twin pregnancies with ICP have significantly increased risks of adverse perinatal outcomes including stillbirth and preterm birth. Stillbirth occurs at an earlier gestational age in twin gestation compared to singletons, suggesting that earlier scheduled delivery should be considered in these women.
authors.affiliation: a Obstetrics Department , International Peace Maternity & Child Health Hospital, Shanghai Jiaotong University , Shanghai , China and.
authors.forename: Xiaohua
authors.initials: X
authors.lastname: Liu
authors.affiliation: b Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology , The Ohio State University College of Medicine , OH , USA.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Landon
authors.affiliation: a Obstetrics Department , International Peace Maternity & Child Health Hospital, Shanghai Jiaotong University , Shanghai , China and.
authors.forename: Yan
authors.initials: Y
authors.lastname: Chen
authors.affiliation: a Obstetrics Department , International Peace Maternity & Child Health Hospital, Shanghai Jiaotong University , Shanghai , China and.
authors.forename: Weiwei
authors.initials: W
authors.lastname: Cheng
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D002780:Cholestasis, Intrahepatic / Q000453:epidemiology*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D059285:Pregnancy, Twin / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: Intrahepatic cholestasis of pregnancy; preterm birth; stillbirth; twin pregnancies