Correlation of bile acids and aspartate-aminotransferase with outcomes in cholestasis of pregnancy


OBJECTIVE: To identify laboratory data that correlates with poor perinatal outcomes.

METHODS: A retrospective chart review of women with intrahepatic cholestasis of pregnancy (ICP), admitted for delivery between January 1, 2013 and December 31, 2017, was performed. Chi-square, student’s t -test, and ANOVA statistical analysis was performed. The receiver-operator characteristic curves were plotted for the prediction of each category of perinatal outcome and the areas under the curves were determined. All p -values were two-sided, and p  < 0.05 was considered statistically significant.

RESULTS: Analysis of the 61 ICP cases showed no occurrence of the intrauterine fetal demise (IUFD), stillbirth, abruption, or neonatal demise. ROC curve analysis revealed a statistically significant correlation between bile acid and AST levels and perinatal outcomes. A bile acid (BA) level equal to or greater than 37μmol/L strongly predicted spontaneous preterm labor in women affected by ICP with a sensitivity of 100% and specificity of 60.70% (p  = 0.002). A BA level equal to or greater than 42μmol/L strongly predicted meconium-stained amniotic fluid with a sensitivity of 85.70% and specificity of 66.70% (p  = 0.006). AST levels equal to or greater than 62 IU/L strongly predicted NICU admission with a sensitivity of 81.30% and specificity of 62.20% (p  = 0.002). AST levels equal to or greater than 75 IU/L strongly predicted hyperbilirubinemia in the neonates with a sensitivity of 87.50% and specificity of 69.80% (p  = 0.001).

CONCLUSIONS: There is a statistically significant correlation between elevated BA and elevated AST levels and adverse perinatal outcomes. 

*Corresponding Author: 

Alexander L. Juusela, MD, MPH, Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA. Tel.: +1 973 926 4882; E-mail: