Peak Total Bile Acids and Adverse Perinatal Outcomes in Intrahepatic Cholestasis of Pregnancy: A Retrospective Cohort Study with Threshold Analysis
- 1Department of Obstetrics and Gynecology, Ankara Etlik City Hospital, Ankara 06170, Türkiye
- 2Department of Perinatology, Ankara Etlik City Hospital, Ankara 06170, Türkiye
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. Results: The categories included 185, 70, and 25 pregnancies, with CAPO in 31 (16.8%), 19 (27.1%), and 19 (76.0%), respectively (p < 0.001). In the ≥100 µmol/L group, the exact 95% confidence interval for CAPO was 54.9–90.6%. The apparent area under the curve was 0.700 (95% confidence interval 0.625–0.772). The 61.3 µmol/L threshold yielded 50.7% sensitivity and 83.9% specificity. Peak bile acids per 10 µmol/L (adjusted odds ratio 1.20, 95% confidence interval 1.11–1.31) and hypertensive disorders (3.27, 1.30–8.23) were independently associated with CAPO. Conclusions: Peak bile acids showed moderate discrimination within this managed cohort. The ≥100 µmol/L subgroup had higher morbidity but imprecise estimates. The same-cohort-derived 61.3 µmol/L threshold is exploratory and requires independent validation; it should not determine delivery timing.
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BibTeX
@article{aktas2026peak,
title = {{Peak Total Bile Acids and Adverse Perinatal Outcomes in Intrahepatic Cholestasis of Pregnancy: A Retrospective Cohort Study with Threshold Analysis}},
author = {Türkan Dikici Aktaş and Özgür Volkan Akbulut and Bengisu Elüstü Çakır and Emel Özalp and Belgin Savran Üçok and Şevki Çelen},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15207837},
url = {https://www.mdpi.com/2077-0383/15/20/7837},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Peak Total Bile Acids and Adverse Perinatal Outcomes in Intrahepatic Cholestasis of Pregnancy: A Retrospective Cohort Study with Threshold Analysis
AU - Türkan Dikici Aktaş
AU - Özgür Volkan Akbulut
AU - Bengisu Elüstü Çakır
AU - Emel Özalp
AU - Belgin Savran Üçok
AU - Şevki Çelen
PY - 2026
DA - 2026/10/11
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15207837
UR - https://www.mdpi.com/2077-0383/15/20/7837
AB - 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. Results: The categories included 185, 70, and 25 pregnancies, with CAPO in 31 (16.8%), 19 (27.1%), and 19 (76.0%), respectively (p < 0.001). In the ≥100 µmol/L group, the exact 95% confidence interval for CAPO was 54.9–90.6%. The apparent area under the curve was 0.700 (95% confidence interval 0.625–0.772). The 61.3 µmol/L threshold yielded 50.7% sensitivity and 83.9% specificity. Peak bile acids per 10 µmol/L (adjusted odds ratio 1.20, 95% confidence interval 1.11–1.31) and hypertensive disorders (3.27, 1.30–8.23) were independently associated with CAPO. Conclusions: Peak bile acids showed moderate discrimination within this managed cohort. The ≥100 µmol/L subgroup had higher morbidity but imprecise estimates. The same-cohort-derived 61.3 µmol/L threshold is exploratory and requires independent validation; it should not determine delivery timing.
SN - 2077-0383
ER -