Assessment of perinatal outcomes in intrahepatic cholestasis of pregnancy in relation to transaminase and bile acid levels.

OBJECTIVE: To examine whether maternal peak bile acids (BA) and aminotransferases predict adverse perinatal outcomes, particularly preterm birth, in hospitalized patients with intrahepatic cholestasis of pregnancy (ICP). METHODS: This retrospective cohort study included 179 singleton pregnancies complicated by ICP. Patients were stratified according to peak BA levels (< 40 vs. ≥ 40 µmol/L) and ALT categories (≤ 25, 25–125, > 125 IU/L). The primary outcome was preterm birth (< 37 weeks). Secondary outcomes included fetal distress, meconium-stained amniotic fluid, NICU admission, gestational age at diagnosis and delivery, birth weight, and length of hospitalization. Receiver operating characteristic (ROC) analyses were performed to evaluate the discriminatory ability of laboratory parameters, and multivariable logistic regression analysis was used to identify independent predictors of preterm birth. RESULTS: Preterm birth occurred in 27.4% of pregnancies (49/179). BA ≥ 40 µmol/L was associated with earlier diagnosis and delivery and longer hospitalization. Increasing ALT categories were associated with earlier diagnosis and delivery, longer hospitalization, and lower birth weight. ALT showed the highest discriminatory performance for predicting preterm birth (AUC 0.70), followed by AST and BA (AUC 0.68 for both). In multivariable analysis, BA ≥ 40 µmol/L and ALT > 125 IU/L remained independently associated with preterm birth. CONCLUSION: In hospitalized patients with ICP, elevated bile acid and ALT levels are independently associated with an increased risk of preterm birth. Combined evaluation of bile acids and aminotransferases may improve risk stratification and support individualized surveillance and delivery planning.