Impact of maternal nutrition and gestational weight gain on perinatal outcomes in intrahepatic cholestasis of pregnancy

OBJECTIVE: The aim of this study was to investigate the relationship between intrahepatic cholestasis of pregnancy and maternal nutritional intake, and to evaluate the impact of maternal nutritional status on maternal and fetal outcomes. METHODS: This prospective case-control study enrolled 38 women with intrahepatic cholestasis of pregnancy and 76 age- and body mass index-matched controls between 2022 and 2023. Dietary intake was assessed using 24-h recall interviews and a 60-item food frequency questionnaire. Nutrient adequacy was calculated relative to age- and pregnancy-specific Dietary Reference Intakes. Maternal anthropometrics and gestational weight gain were recorded, alongside maternal and neonatal outcomes. RESULTS: Women with intrahepatic cholestasis of pregnancy had significantly lower energy intake (p=0.004) and gestational weight gain (p<0.001). Nutrient adequacy analyses indicated comprehensive deficiencies, with significantly lower adequacy for energy, protein, fiber, folate, magnesium, potassium, and iron (all p<0.01). Intrahepatic cholestasis of pregnancy was associated with earlier delivery (p<0.001), lower neonatal birth weight (p<0.001), and higher neonatal intensive care unit admission rates (p=0.007). Within the intrahepatic cholestasis of pregnancy group, maternal fasting bile acid levels inversely correlated with gestational age at delivery (ρ=-0.408, p=0.011). Gestational weight gain positively correlated with neonatal birth weight (ρ=0.325, p=0.046). CONCLUSION: Intrahepatic cholestasis of pregnancy is associated with significant maternal nutritional inadequacy and insufficient gestational weight gain. Optimizing maternal nutritional status represents a potentially modifiable pathway for targeted intervention in the comprehensive management of intrahepatic cholestasis of pregnancy.