The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal ObstetriciansSep 15, 2015

Birth outcomes in twin pregnancies affected by liver bile flow problems during pregnancy

Circadian Biology Weekly Brief ↗PubMed ↗DOI ↗

Updated Apr 3, 2026

Abstract

6.7% of twin pregnancies were complicated by intrahepatic cholestasis of pregnancy (ICP), compared to 1.3% of singleton pregnancies.

Twin pregnancies with ICP showed a stillbirth rate of 3.9%, significantly higher than the 0.8% in non-ICP twins.
The adjusted odds ratio for stillbirth in twin pregnancies with ICP was 5.75, indicating a notably increased risk.
Stillbirths in twin pregnancies complicated by ICP occurred earlier, between 33 and 35 weeks, compared to 36-38 weeks in singletons.
Twin pregnancies with ICP had a 4.17 times higher risk of preterm birth before 37 weeks.
Meconium staining of amniotic fluid and lower birth weight were also observed in twin pregnancies affected by ICP.

Simplified

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.

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Birth outcomes in twin pregnancies affected by liver bile flow problems during pregnancy

Abstract

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