Abstract: Objective To investigate the risk factors for intrahepatic cholestasis of pregnancy (ICP) patients with chronic hepatitis B (CHB) during pregnancy, and to establish a corresponding risk prediction model, to furnish a basis for early clinical intervention and management. Methods A total of 149 pregnant patients with chronic hepatitis B (CHB) treated at Shangqiu Maternal and Child Health Hospital from March 2021 to March 2024 were selected. They were grouped by the presence or absence of ICP. Significant variables were screened via univariate analysis, followed by multivariate Logistic regression analysis. A nomogram model was constructed and validated. Results A total of 149 pregnant patients with CHB were included, among which 21 patients were in the ICP group (14.09%), and 128 patients were in the non- ICP group (85.91%). Univariate analysis revealed that the ICP group had a higher prevalence of cholelithiasis [42.86% (9/21) vs. 21.88% (28/128)], gestational hypertension [23.81% (5/21) vs. 7.81% (10/128)], elevated TBA (15.51 ± 2.31 μmol/L vs. 11.19 ± 3.24 μmol/L), elevated ALT (115.72 ± 12.29 U/L vs. 85.62 ± 8.81 U/L), and elevated HBV pgRNA (5.40 ± 0.69 lg copies/mL vs. 4.28 ± 0.51 lg copies/mL) compared to the non-ICP group (P<0.05). Multivariate logistic regression analysis showed that cholelithiasis [OR=15.340 (95% CI: 1.124~209.390)], pregnancy-induced hypertension [OR=15.618 (95% CI: 1.310~186.220)], high TBA [OR=1.438 (95% CI: 1.074~1.924)], high ALT [OR=1.233 (95% CI: 1.107~1.373)], and high HBV pgRNA [OR=40.620 (95% CI: 2.253~732.301)] were risk factors for ICP patients with CHB. Receiver operating characteristic (ROC) curve analysis indicated that the combined prediction of all items had a high value, with an area under the curve (AUC) value of 0.988, a sensitivity of 95.2%, and a specificity of 96.1%. A nomogram and a calibration curve were constructed, which showed a good fit. Conclusion Cholelithiasis, pregnancy - induced hypertension, TBA, ALT, and HBV pgRNA are the main risk factors for ICP in pregnant patients with CHB, providing valuable prediction basis for clinicians.

Key words: Chronic hepatitis B, Pregnancy, Intrahepatic cholestasis of pregnancy, Risk factors, Logistic regression