Abstract: Objective To investigate the risk factors for adverse pregnancy outcomes in patients with intrahepatic cholestasis of pregnancy (ICP) and to develop a prediction model, providing a theoretical basis for early clinical intervention. Methods A retrospective analysis was conducted on the 168 ICP patients who visited our hospital from September 2021 to August 2024. Based on whether adverse pregnancy outcomes occurred, the patients were divided into an adverse outcome group (54 cases) and a favorable outcome group (114 cases). Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for adverse pregnancy outcomes in ICP patients. Furthermore, the predictive value of each risk factor for adverse pregnancy outcomes was assessed using receiver operating characteristic (ROC) curves, and a prediction model was established by combining clinical parameters. Results In the adverse outcome group, the levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bile acids (TBA), neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), and activated partial thromboplastin time (APTT) were (38.02±6.75) U/L, (36.58±7.46) U/L, (44.85±5.33) μmol/L, (5.78±1.10), (14.13±3.27) fL, and (48.59±6.57) s, respectively, which were higher than those in the good outcome group, with values of (30.38±5.95) U/L, (27.90±5.53) U/L, (42.48±5.90) μmol/L, (4.99±0.92), (12.29±2.74) fL, and (43.65±5.75) s (P<0.05). Multivariate logistic regression analysis revealed that high levels of AST, ALT, TBA, NLR, MPV, and APTT were independent risk factors for adverse pregnancy outcomes in ICP patients (P<0.05). The sensitivities of AST, ALT, and TBA for predicting adverse pregnancy outcomes were 74.1%, 75.9%, and 50.0%, with specificity values of 75.4%, 79.8%, and 71.1%, and AUC values of 0.811, 0.826, and 0.612, respectively. The sensitivities of NLR, MPV, and PT were 83.3%, 44.4%, and 55.6%, with specificity values of 45.6%, 84.2%, and 82.5%, and AUC values of 0.695, 0.666, and 0.711, respectively. When these indicators were combined, the sensitivity and specificity were 92.6% and 92.1%, respectively, with an AUC of 0.958. Conclusion AST, ALT, TBA, NLR, MPV, and PT are independent risk factors for adverse pregnancy outcomes in ICP patients. Elevated levels of these indicators significantly increase the risk of adverse pregnancy outcomes and can provide a theoretical basis for early prediction and intervention in clinical practice.

Key words: Intrahepatic cholestasis of pregnancy, Adverse pregnancy outcomes, Risk factors, Prediction model