Impact of elevated maternal bile acid levels on fetomaternal outcomes in intrahepatic cholestasis of pregnancy: a retrospective observational study

Abstract

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.