Background: Intrahepatic cholestasis of pregnancy (ICP) is a
common liver disorder specific to pregnancy. Taurocholic acid (TCA) has been
implicated in the pathogenesis of ICP. This study aimed to investigate the
association between serum TCA levels and adverse maternal and infant outcomes in
women with ICP. Methods: Pregnant women diagnosed with ICP were
categorized into normal or adverse groups based on their pregnancy outcomes.
Baseline data, including age, pre-pregnancy body mass index (BMI), systolic blood
pressure (SBP), diastolic blood pressure (DBP), and fasting blood sample (5 mL),
were collected at 28 weeks of gestation. Serum levels of total bile acid (TBA),
alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBIL),
and TCA were measured using a fully automatic biochemical analyzer. The
predictive value of serum TCA levels for adverse outcomes in ICP was analyzed
using receiver operating characteristic (ROC)
curve analysis. Subsequently, ICP patients were divided into high and low TCA
expression groups, and the changes in baseline data and adverse outcomes were
compared between the groups. The relationship between serum TCA levels and
adverse outcomes was evaluated using adverse maternal and infant outcome curves.
Logistic regression analysis was performed to identify independent risk factors
for adverse outcomes in ICP patients. Results: The
adverse outcome group showed significant differences in
gestational age at delivery (median value of 37 years old,
p = 0.0001), levels of TBA (mean standard
deviation 47.05 6.43 µmol/L, p
0.0001), ICP severity (proportion of severe ICP patients was
85.14%, p 0.0001), ALT (mean standard
deviation 82.59 6.29 U/L, p 0.0001), AST (median value of
67.50 U/L, p 0.0001), and TBIL (mean standard deviation
47.05 6.99 µmol/L, p 0.0001), compared to the normal
outcome group. Serum TCA levels were higher in the adverse
outcome group (mean standard deviation 17.79
4.56 µmol/L) than in the normal outcome group (mean standard
deviation 11.72 3.68 µmol/L) (p 0.001). Serum
taurocholic acid (TCA) levels demonstrated predictive value for adverse outcomes in
ICP patients, and the areas under the ROC
curve/sensitivity/specificity/cutoff value were 0.8430,
66.22%, 91.03%, and 16.17, respectively. The high TCA
expression group had higher levels of TBA (median value of 43.40 µmol/L,
p 0.0001), ALT (median value of 79.89
µmol/L, p 0.0001), AST (median value of
63.87 µmol/L, p 0.0001), and TBIL (median value of 43.79
µmol/L, p 0.0001), a higher proportion of severe ICP cases
(71.43%, p 0.0001). There were a remarkably increased number of
adverse pregnancy outcomes (postpartum hemorrhage, premature birth, neonatal
asphyxia, fetal distress, amniotic fluid fecal staining, and low birth weight) in
the high TCA expression group (n = 49) compared to the low TCA expression group
(n = 25) (p 0.0001). The
Kaplan-Meier (KM) curve of patients with high TCA expression shifted to the left
compared with patients with low TCA expression (p 0.0001). The
cumulative survival rate of patients with high
serum TCA expression (22.22%) was
prominently reduced compared to patients with low serum TCA
expression (85.03%), indicating that high serum TCA levels
increased the risk of maternal and infant adverse outcomes in ICP patients.
TBAs, AST, and TCA were identified as independent risk factors
for adverse maternal and fetal outcomes in ICP patients. Conclusion:
Serum TCA is an independent risk factor for adverse outcomes in
ICP patients. Serum TCA levels have predictive values for adverse maternal and
infant outcomes in pregnant women with ICP, but there are still some false
positives. In clinical diagnosis, it is essential to combine other clinical data
to increase the diagnostic accuracy.
