Journal of Clinical Medicine
Peak Total Bile Acids and Adverse Perinatal Outcomes in Intrahepatic Cholestasis of Pregnancy: A Retrospective Cohort Study with Threshold Analysis
By Turkan Dikici Aktas, Özgür Volkan Akbulut, Bengisu Elüstü and 3 others.
Abstract
Background
Peak total bile acids guide management of intrahepatic cholestasis of pregnancy (ICP), potentially influencing observed outcomes. We examined their association with a composite adverse perinatal outcome (CAPO) excluding preterm delivery.
Methods
This retrospective cohort included 280 singleton pregnancies with ICP delivered at a tertiary hospital between January 2023 and May 2026. Peak bile acids were categorized as <40, 40–99, or ≥100 µmol/L. CAPO comprised meconium-stained amniotic fluid, nonreassuring fetal status, neonatal intensive care admission, respiratory distress syndrome, transient tachypnea, neonatal death, or intrauterine fetal death. Logistic regression and receiver operating characteristic analysis were performed; the exploratory threshold maximized the Youden index.