Intrahepatic cholestasis of pregnancy and perinatal outcomes in a tertiary care hospital

Background: Intrahepatic cholestasis of pregnancy (IHCP) is a reversible hepatobiliary disorder specific to pregnancy, predominantly manifesting in the third trimester. It is characterized by pruritus and elevated serum bile acid levels and is associated with adverse fetal outcomes. This study aimed to evaluate the maternal and perinatal outcomes in pregnancies complicated by IHCP and to analyze the association between bile acid concentrations and neonatal complications. Materials and Methods: A prospective observational study was conducted on 142 pregnant women diagnosed with IHCP at a tertiary care center from January 2023 to January 2025. Participants were categorized based on serum bile acid levels into mild (10–40 µmol/L), moderate (41–100 µmol/L), and severe (>100 µmol/L) groups. Maternal liver function parameters and perinatal outcomes were assessed and statistically analyzed. Results: Pruritus was observed in all patients. A significant rise in serum aminotransferases (ALT, AST) and bilirubin correlated with increasing bile acid levels (p<0.001). Adverse perinatal outcomes—including low APGAR scores, NICU admissions, and intrauterine fetal demise—were more frequent in patients with moderate-to-severe IHCP. Two cases of intrauterine demise occurred in the moderate group. Conclusion: IHCP is associated with significant maternal biochemical derangements and fetal morbidity. Serum bile acid levels are a useful marker for predicting adverse neonatal outcomes. Early diagnosis, close monitoring, and timely delivery are essential to improving perinatal prognosis.