Obstetric cholestasis (OC) alternatively called intrahepatic cholestasis of pregnancy (ICP), is a cholestasis disorder that primarily happens during second and third trimesters. This can be identified by increased levels of serum bile acids or liver aminotransferase and pruritus in cases where there are no skin rashes. Adverse fetal outcomes such as preterm birth, meconium-stained amniotic fluid, preterm rupture of membranes and sudden stillbirth cause challenges for patients as well as healthcare providers. If there is ICP, then iatrogenic premature birth is used as a preventive measure for reducing the risk of sudden stillbirth. Elevated serum total bile acid (TBA) levels are associated with immediate preterm birth, as they have a significant role in the pathophysiology of preterm labour. Additionally, high bile acid levels may induce vasoconstriction, which can cause the development of a placental villous tree that may affect fetal growth and development.
Maternal serum total bile acids (TBA) can act as an essential biomarker for analysing fetomaternal outcomes in obstetric cholestasis. This can cause significant health effects on both mother as well as child. Early diagnosis and intervention are important for reducing the complications that are related to high bile acid levels. It is recommended for early delivery in case of high severity. Pharmacological interventions like ursodeoxycholic acid administration are commonly used for reducing the symptoms and improving the outcomes.
This study aimed to analyse the differing levels of maternal serum TBA that correlate with both maternal and fetal outcomes in obstetric cholestasis. There are researchers who reported that elevated levels of TBA may increase adverse outcomes like preterm birth and respiratory complications in newborns. However, in terms of the Indian population, the detailed specific outcomes of bile acid increase remain limited. By understanding the impact of different levels of TBA on maternal and fetal outcomes, this study provides clinical guidelines for managing obstetric cholestasis.
A prospective observational and comparative study was carried out for over 12 months in the Department of Obstetrics & Gynaecology at Bokaro General Hospital, India. It involved 84 pregnant women with ICP. Participants were categorized into two groups based on serum TBA levels. Based on inclusion and exclusion criteria maternal and fetal outcomes were assessed through clinical history and examination, laboratory tests, and regular fetal monitoring using non-stress tests and obstetric ultrasound and Doppler studies.
84 patients in this study were divided into two groups equally based on bile acid levels, group A (< 40 µmol/L) and group B (≥ 40 µmol/L). The mean bile acid levels in group A and group B were 16.40 ± 4.47 µmol/L and 43.86 ± 3.93 µmol/L respectively with p < 0.0001.
Significant differences were observed in gestational age of 76.19% in group A delivered at 37 weeks, compared to only 9.52% in group B with p < 0.0001. 2.38% in group A and 64.29% in group B were observed in NICU admission due to respiratory distress. In group B 47.62% of babies weighed < 2.5 kg. In group B, 66.67% babies had MSAF vs 21.43% babies in group A. Other factors like APGAR score comparison also showed statistical significance.
The relationship between maternal serum total bile acid (TBA) levels and fetomaternal outcomes in cases of obstetric cholestasis was correlated in this study. This study comparatively analysed the two groups based on the bile acid levels, that is group A which has TBA 10–39 µmol/L and group B which has TBA ≥40 µmol/L. Some significant differences have been observed between the two groups mainly in gestational age at delivery, fetal distress, NICU admissions, low birth weight, MSAF and neonatal APGAR scores. It was observed that high levels of maternal bile acids may be related to poor fetal outcomes and some adverse maternal events.
This study correlated serum total bile acids with fetomaternal outcomes in obstetric cholestasis and states the implications of bile acid levels that affect pregnancy and its outcomes. The findings of this study have shown that increased bile acids are related to adverse maternal, fetal and neonatal outcomes. That includes earlier gestational age at delivery, increased rates of fetal distress, and higher NICU admissions. Along with that, newborns born to the mother with higher bile acid levels showed lower APGAR scores. This shows the challenges immediately after the delivery. Early detection, early initiation of treatment, stringent fetal surveillance, timely intervention and delivery in our study helped in improving fetal prognosis and helped prevent still birth and fetal demise. This study supported the need for close monitoring of pregnant women for bile acid levels. Bile acid monitoring protocols and management guidelines can be integrated by policymakers or clinicians in case of high-risk pregnancies. This may help in improving the maternal and fetal health outcomes.
Source: Sridhar et al. / Indian Journal of Obstetrics and Gynecology Research 2025;12(3):487–494
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