İntrahepatik Kolestaz Tanılı Gebelerde Perinatal Sonuçlar: Son Üç Yılın Verileriyle Retrospektif Bir Değerlendirme

Abstract

Bu retrospektif kohort çalışmada, intrahepatik kolestaz tanısı almış gebeliklerde maternal ve neonatal sonuçlar değerlendirilmiş ve bu bulgular, yaş, parite ve tanı haftası açısından eşleştirilmiş sağlıklı gebeliklerle karşılaştırılmıştır. Ocak 2022 ile Ocak 2025 tarihleri arasında Türkiye’de bir üçüncü basamak sağlık merkezinde takip edilen 70 intrahepatik kolestazlı gebe ile 240 sağlıklı kontrol gebelik çalışmaya dahil edilmiştir. Maternal demografik veriler, laboratuvar bulguları, obstetrik özellikler ve neonatal sonuçlar karşılaştırılmış; ayrıca safra asidi düzeyinin şiddetine ve tanı zamanına (erken ya da geç başlangıç) göre alt grup analizleri yapılmıştır. Bulgular, intrahepatik kolestazın preterm doğum, düşük doğum ağırlığı, yenidoğan yoğun bakım ünitesine yatış oranı ve Apgar skorlarında düşüş gibi olumsuz perinatal sonuçlarla anlamlı şekilde ilişkili olduğunu göstermiştir. Şiddetli kolestaz (≥100 μmol/L), daha erken doğum ve daha yüksek düşük doğum ağırlığı insidansı ile bağlantılı bulunmuştur. Erken başlangıçlı olgularda ise daha sık mekonyumla boyanmış amniyon sıvısı ve daha düşük kordon pH değerleri saptanmıştır. Ursodeoksikolik asit tedavisi yaygın olarak uygulanmış olsa da, özellikle şiddetli ve erken başlangıçlı olgularda tedaviye yanıt sınırlı kalmıştır. Sonuç olarak, intrahepatik kolestaz, özellikle erken başlangıçlı ya da yüksek safra asidi düzeyine sahip olgularda ciddi perinatal riskler oluşturmaktadır. Bu nedenle erken tanı, düzenli safra asidi izlemi ve bireyselleştirilmiş obstetrik yönetim önerilmektedir. Tanı eşiklerinin netleştirilmesi ve doğum planlamasının optimize edilmesi için ileriye dönük çalışmalara ihtiyaç vardır.

Keywords

• Gebelik kolestazı
• Safra asitleri
• Erken doğum
• Yenidoğan sonuçları
• Perinatal morbidite

Perinatal Outcomes in Pregnancies Diagnosed with Intrahepatic Cholestasis: A Retrospective Analysis Based on the Last Three Years of Data

Abstract

This retrospective cohort study aimed to evaluate maternal and neonatal outcomes in pregnancies complicated by intrahepatic cholestasis of pregnancy (ICP) and to compare them with matched healthy controls. A total of 70 women diagnosed with ICP and 240 controls matched for age, parity, and year were included. All participants were followed at a tertiary care center in Turkey between January 2022 and January 2025. Maternal demographics, laboratory results, obstetric characteristics, and neonatal outcomes were assessed. Subgroup analyses were conducted according to the severity of bile acid elevation and the timing of ICP diagnosis (early vs. late onset). The presence of ICP was significantly associated with increased rates of preterm delivery (35.7% vs. 5.8%, p<0.001), lower birth weight (2888±371 g vs. 3295±467 g, p<0.001), higher NICU admission (30% vs. 7.9%, p<0.001), and reduced Apgar scores. Severe ICP (≥100 μmol/L) correlated with earlier delivery and a higher incidence of low birth weight (71.4%, p<0.001). Early-onset ICP was linked to a higher frequency of meconium-stained amniotic fluid and lower cord pH levels. Although ursodeoxycholic acid (UDCA) therapy was commonly administered, clinical response remained limited in severe and early-onset cases. In conclusion, ICP is significantly associated with adverse perinatal outcomes, particularly when presenting early or with severe bile acid elevation. Early diagnosis, close monitoring of bile acid levels, and individualized management strategies may help reduce fetal risks. Further prospective studies are warranted to clarify diagnostic thresholds and optimize the timing of delivery.

Keywords

• Intrahepatic cholestasis of pregnancy
• Bile acids
• Preterm birth
• Neonatal outcomes
• Perinatal morbidity

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