Objective
COVID-19 infection has been shown to cause hepatic injury, which may be exacerbated among obstetric patients experiencing other liver complications. We sought to determine whether the incidence and severity of IHCP was increased during the COVID era compared to the pre-pandemic period, since universal antepartum testing was not available to determine associations.
Study Design
This was a retrospective cohort study of all births within a four-hospital system with 14,000 annual births. IHCP was defined by ICD-10 code. The pre-COVID period was defined as January 2018 to December 2019 and stratified in 6 month intervals due to the reported seasonality of IHCP. The COVID period was defined as January-June 2020. IHCP was defined as total bile acid (BA) >10 or clinician determination. Demographic and outcome data were abstracted via chart review. Statistics were performed with odds ratio, chi-square, and t-test when appropriate.
Results
In the pre-COVID era there were 329 cases of IHCP with an incidence of 1.18%, which did not differ from the 95 incident cases in the COVID era (1.36%, OR 1.16, p=0.21). No differences were observed seasonally across 6-month intervals. Compared with a representative sample of 184 cases, severe cholestasis with BA >40 was increased during COVID (OR 2.17, 95% CI 1.2-4.0, p=0.014). Though mean BA level was unchanged (29 vs 31), peak BA (210 vs 249), AST mean (51 vs 85, p=0.007) and peak (514 vs 680), and ALT mean (66 vs 114, p=0.013) and peak (749 vs 881) were increased in the COVID era. Four patients with IHCP had confirmed COVID. Compared to the pre-COVID cohort, these COVID patients had similar BA (24 vs 29), but elevated AST (mean 166 vs 51, p<0.001, peak 376) and ALT (mean 200 vs 66, p=0.007, peak 375).
Conclusion
In the COVID era, incidence of IHCP was unchanged. However, subjects with IHCP with and without documented COVID during the COVID era had more severe disease. The observed elevations in bile acids, AST and ALT during the COVID era cohort suggest that even mild or undetected COVID infection may worsen IHCP.