Serial aminotransferase changes and perinatal outcomes in intrahepatic cholestasis of pregnancy

Purpose: The aim of this study was to evaluate serial aminotransferase changes and whether biochemical improvement differed according to neonatal intensive care unit admission in pregnancies complicated by intrahepatic cholestasis of pregnancy.Materials and Methods: This retrospective cohort study included 59 women followed between February 2018 and August 2023. Maternal, obstetric, laboratory, delivery, and neonatal data were obtained from medical records. Alanine aminotransferase and aspartate aminotransferase measurements were recorded chronologically, although follow-up intervals were not standardized. First-to-last aminotransferase changes were evaluated, and maternal biochemical parameters were compared according to neonatal intensive care unit admission.Results: Preterm delivery occurred in 33 pregnancies (55.9%), and 31 of these births (93.9%) were iatrogenic. Twenty-one newborns (35.6%) were admitted to the neonatal intensive care unit. Median alanine aminotransferase levels decreased from 88.0 [54.5–187.0] to 55.0 [17.5–125.0] U/L in 55 women, and median aspartate aminotransferase levels decreased from 70.0 [32.5–116.5] to 35.0 [22.0–46.5] U/L in 59 women. Alanine aminotransferase percentage change was 23.3% [-14.8 to 54.6] in newborns without neonatal intensive care unit admission and 37.9% [22.4 to 49.2] in those with admission. Aspartate aminotransferase percentage change was 27.2% [1.6 to 60.1] and 44.3% [20.8 to 60.8], respectively. Among the 39 women with available bile acid data, peak bile acid levels were 21.9 [10.7–55.2] µmol/L in the no-admission group and 22.7 [15.1–34.5] µmol/L in the admission group. Newborns admitted to the neonatal intensive care unit had lower gestational age at birth (35.4 [34.0–36.0] vs. 37.4 [36.0–38.1] weeks) and lower birth weight (2350.0 [2000.0–2730.0] vs. 2890.0 [2697.5–3267.5] g) than non-admitted newborns.Conclusion: Serial aminotransferase improvement may be insufficient for neonatal risk stratification in intrahepatic cholestasis of pregnancy. Biochemical response should be interpreted together with obstetric and clinical risk indicators.