Impact of elevated maternal bile acid levels on fetomaternal outcomes in intrahepatic cholestasis of pregnancy: a retrospective observational study
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20263406Keywords:
Intrahepatic cholestasis of pregnancy, Bile acids, Ursodeoxycholic acid, Pregnancy outcomes, Perinatal outcomes, Retrospective studyAbstract
Background: Intrahepatic cholestasis of pregnancy (ICP) is a reversible liver disorder associated with elevated maternal bile acids and adverse perinatal outcomes. The degree of bile acid elevation is considered a key prognostic marker. To evaluate the impact of elevated maternal bile acid levels on maternal and neonatal outcomes and to identify bile acid thresholds associated with adverse pregnancy outcomes.
Methods: A retrospective study was conducted at Mediclinic Welcare Hospital, Dubai, from January 2023 to December 2024. Sixty pregnant women diagnosed with ICP were included after exclusion of incomplete records. Patients were categorized based on bile acid levels into gestational pruritus (<19 µmol/l), mild (19–39 µmol/l), moderate (40–99 µmol/l), and severe (≥100 µmol/l). Maternal and neonatal outcomes were analyzed.
Results: Most patients had gestational pruritus (65%) followed by mild (26.7%), moderate (6.7%), and severe ICP (1.7%). The majority were South Asian (73.3%) and multigravida (61.7%). No significant association was found between bile acid levels and maternal complications. Term delivery occurred in 83.3% of cases. Neonatal outcomes were favorable in 71.7%, with NICU admissions (26.7%) primarily due to respiratory distress rather than bile acid severity. Ursodeoxycholic acid therapy improved bile acid levels in nearly half of the cases.
Conclusions: Intrahepatic cholestasis of pregnancy was associated with favourable maternal and neonatal outcomes in this cohort when managed with close antenatal surveillance, bile acid monitoring, and individualized timing of delivery.
Metrics
References
Cimilli Senocak GN, Topdagi Yilmaz EP. Maternal and fetal outcomes in pregnancies complicated by intrahepatic cholestasis. Eurasian J Med. 2019;51(3):270-2. DOI: https://doi.org/10.5152/eurasianjmed.2019.18447
Reyes H, González MC, Ribalta J, et al. Prevalence of intrahepatic cholestasis of pregnancy in Chile. Ann Intern Med. 1978;88:487-93. DOI: https://doi.org/10.7326/0003-4819-88-4-487
Brouwers L, Koster MPH, Page-Christiaens GCML, et al. Intrahepatic cholestasis of pregnancy: maternal and fetal outcomes associated with elevated bile acid levels. Am J Obstet Gynecol. 2015;212(1):100.e1-100.e7. DOI: https://doi.org/10.1016/j.ajog.2014.07.026
Hobson SR, Cohen ER, Gandhi S. Diagnosis and management of intrahepatic cholestasis of pregnancy. J Obstet Gynaecol Can. 2024;46:102618. DOI: https://doi.org/10.1016/j.jogc.2024.102618
Geenes V, Williamson C. Intrahepatic cholestasis of pregnancy. World J Gastroenterol. 2009;15(17):2049-66. DOI: https://doi.org/10.3748/wjg.15.2049
Upreti P. Intrahepatic cholestasis of pregnancy and fetomaternal outcomes: a retrospective study from Uttarakhand, India. J South Asian Feder Obst Gynae. 2024;16(5):479-85. DOI: https://doi.org/10.5005/jp-journals-10006-2459
Çalık MG, Çelik ÖY, Köksal Z, Yücel A. Assessment of perinatal outcomes in intrahepatic cholestasis of pregnancy in relation to transaminase and bile acid levels. BMC Pregnancy Childbirth. 2026;26:567. DOI: https://doi.org/10.1186/s12884-026-09064-7
Li P, Jiang Y, Xie M, You Y. Factors associated with intrahepatic cholestasis of pregnancy and its influence on maternal and infant outcomes. Medicine (Baltimore). 2023;102(1):e32586. DOI: https://doi.org/10.1097/MD.0000000000032586
Crites K, Shanks AL, Maines J. Pregnancy intrahepatic cholestasis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2026. Available at: https://www.ncbi.nlm.nih.gov/books/NBK551503/. Accessed on 17 May 2026.
Niculae LE, Niculae AS, Tocariu R, Petca A. Impact of intrahepatic cholestasis of pregnancy on neonatal respiratory outcomes (CHOLE-RESP): protocol for a prospective cohort study. Front Pediatr. 2026;14:1640579. DOI: https://doi.org/10.3389/fped.2026.1640579
Feng F, Li J, Liao J, Qin S, Liu Y, Che X, et al. Associations of clinical subtypes and bile acid levels of intrahepatic cholestasis of pregnancy with pregnancy outcomes. Sci Rep. 2024;14:12185. DOI: https://doi.org/10.1038/s41598-024-63183-9
Ovadia C, Seed PT, Sklavounos A, Geenes V, Di Ilio C, Chambers J, et al. Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. Lancet. 2019;393(10174):899-909. DOI: https://doi.org/10.1016/S0140-6736(18)31877-4
Naga VKM, Joseph B, Kalappa MS. Obstetric outcome in women with intrahepatic cholestasis: a 3-year study in a tertiary care hospital in Bengaluru. J South Asian Feder Obst Gynae. 2019;11(2):103-6. DOI: https://doi.org/10.5005/jp-journals-10006-1662
Granese R, Calagna G, Alibrandi A, Martinelli C, Romeo P, Filomia R, et al. Maternal and neonatal outcomes in intrahepatic cholestasis of pregnancy. J Clin Med. 2023;12(13):4407. DOI: https://doi.org/10.3390/jcm12134407
Majewska A, Seed PT, Chambers J, Dixon PH, Geenes V, Worrall AR, et al. Stillbirth in intrahepatic cholestasis of pregnancy and timing of severely elevated bile acid concentrations: an observational cohort study. Eur J Obstet Gynecol Reprod Biol. 2026;316:114800. DOI: https://doi.org/10.1016/j.ejogrb.2025.114800
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Jijisha Ali, Aisha Saifi, Janaki Gopalan, George Alexander
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
