{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T22:20:12Z","timestamp":1777674012434,"version":"3.51.4"},"reference-count":26,"publisher":"Georg Thieme Verlag KG","issue":"10","funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["T32 HD007203-42"],"award-info":[{"award-number":["T32 HD007203-42"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>This study aimed to assess the association between increasing bile acid levels in pregnancies with cholestasis and adverse outcomes.<\/jats:p><jats:p>This is a retrospective cohort study of singleton, non-anomalous gestations complicated by cholestasis delivered at a single academic medical center from 2005 to 2019. We compared rates of adverse outcomes in pregnancies complicated by mild cholestasis (initial total bile acid [TBA] &lt;40\u2009\u03bcmol\/L and peak TBA &lt;40\u2009\u03bcmol\/L), progressive cholestasis (initial TBA &lt;40\u2009\u03bcmol\/L and peak TBA \u226540\u2009\u03bcmol\/L), and severe cholestasis (initial TBA \u226540\u2009\u03bcmol\/L). Our primary outcome was a composite adverse outcome including spontaneous preterm labor and delivery, umbilical artery pH &lt;7.20, 5-minute Apgar &lt;7, cesarean delivery for nonreassuring fetal heart rate tracing, meconium-stained amniotic fluid, and neonatal intensive care unit (NICU) admission. Analyses were performed using mild cholestasis as the base comparator and a second analysis using severe cholestasis as the base comparator.<\/jats:p><jats:p>Of the 1,182 pregnancies complicated by cholestasis, 732 (61.9%) had mild cholestasis, 78 (6.6%) had progressive cholestasis, and 372 (31.5%) had severe cholestasis. After adjusting for confounders including gestational age at diagnosis and using mild cholestasis as the base comparator, both progressive and severe cholestasis were associated with the composite adverse outcome (progressive intrahepatic cholestasis of pregnancy [ICP], OR\u2009=\u20091.70; 95% CI: 1.04\u20132.78 and severe ICP, OR\u2009=\u20091.60; 95% CI: 1.24\u20132.06). When using progressive cholestasis as the base comparator, there were no statistically significant differences in the primary or secondary outcomes between progressive cholestasis and severe cholestasis.<\/jats:p><jats:p>This study highlights the significance of monitoring peak bile acid levels and that some cases of cholestasis may progress in pregnancy and the adverse associations are better reflected by the peak TBA level and not the cholestasis severity at initial diagnosis.<\/jats:p>","DOI":"10.1055\/a-2483-5910","type":"journal-article","created":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T00:14:51Z","timestamp":1732666491000},"page":"1235-1242","source":"Crossref","is-referenced-by-count":2,"title":["Adverse Outcomes Associated with Progressive Intrahepatic Cholestasis of Pregnancy"],"prefix":"10.1055","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2677-3023","authenticated-orcid":false,"given":"Minhazur R.","family":"Sarker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Science, University of California San Diego, San Diego, California"},{"name":"Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, New York"},{"name":"Department of Obstetrics, Gynecology and Reproductive Science, New York City Health and Hospitals, Elmhurst Hospital Center, Elmhurst, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dana","family":"Canfield","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Science, University of California San Diego, San Diego, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren","family":"Ferrara","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, New York"},{"name":"Department of Obstetrics, Gynecology and Reproductive Science, New York City Health and Hospitals, Elmhurst Hospital Center, Elmhurst, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gladys A.","family":"Ramos","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Science, University of California San Diego, San Diego, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9532-4109","authenticated-orcid":false,"given":"Chelsea A.","family":"DeBolt","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, New York"},{"name":"Department of Obstetrics, Gynecology and Reproductive Science, New York City Health and Hospitals, Elmhurst Hospital Center, Elmhurst, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,12,24]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"G1","DOI":"10.1152\/ajpgi.00028.2017","article-title":"Pregnancy and bile acid disorders","volume":"313","author":"V Pataia","year":"2017","journal-title":"Am J Physiol Gastrointest Liver Physiol"},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1002\/hep.510260216","article-title":"Intrahepatic cholestasis of pregnancy: a French prospective study","volume":"26","author":"Y Bacq","year":"1997","journal-title":"Hepatology"},{"issue":"17","key":"ref3","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.3748\/wjg.15.2049","article-title":"Intrahepatic cholestasis of pregnancy","volume":"15","author":"V Geenes","year":"2009","journal-title":"World J 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