Intrahepatic Cholestasis of Pregnancy: Fetomaternal Outcome Associated with Elevated Levels of Bile Acids

Abstract

Background: Intrahepatic cholestasis of pregnancy (ICP) is a severe, pregnancy-specific hepatic disease that is marked by maternal pruritus, no rash, and high levels of serum bile acid . Although maternal morbidity is minimal, ICP strongly associated with serious fetal complications, such as spontaneous preterm birth and respiratory distress syndrome.

Objectives: To compare the frequency of adverse feto-maternal outcome in females with and without Intra-hepatic cholestasis of pregnancy.

Methodology: A comparative cross-sectional study was carried out in the Department of Obstetrics and Gynaecology, DHQ Teaching Hospital, Mirpur from 1 December 2025 to 4 March 2026. 190 pregnant females (18-40 years with gestation of over 24 weeks, n = 190) were identified as Group I (with ICP) and Group II (normal pregnancies). Data analysis was performed on SPSS version 22 by use of Chi-square tests. The level of statistical significance was p ≤ 0.05.

Results: Baseline demographics were well-matched, though baseline maternal comorbidities included gestational diabetes mellitus (14.7%) and pregnancy-induced hypertension (7.9%) across the sample. Preterm birth was significantly higher in Group I (18.9%) than in Group II (2.1%) (p < 0.001). Stratified analysis within Group I revealed that preterm delivery rates increased alongside fasting serum bile acid severity tiers, rising from 13.2% in mild cases to 35.3% in severe cases. Differences in operative cesarean sections (29.5% vs 22.1%, p = 0.245) and neonatal respiratory distress syndrome (9.5% vs 6.3%, p = 0.412) were not statistically significant.

Conclusion: ICP exhibits a strong clinical association with adverse fetomaternal outcomes, most notably an elevated risk of preterm birth that scales progressively with the severity of maternal bile acid elevation. Regular biochemical monitoring is an important tool for risk stratification