Abstract: Objective To explore the risk factors of intrahepatic cholestasis (ICP) in twin pregnancies and analyze its clinical features.Methods In this study, twin-pregnancy women who delivered in the Department of Obstetrics and Gynecology at our hospital between October 2019 and October 2021 were recruited, and were divided into ICP group (n=37) and non-ICP group (n=193); In the ICP group, 37 perinatal women were randomly selected,for data collection. The information on various biochemical markers including total bile acid (TBA), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were recorded. Along with these data, the fetal prognosis for each case was also recorded.Results Out of the total subjects, 37 cases(16.09%) had ICP; of these, 34 cases were mild ICP, and 3 cases were severe,ICP occurrence was observed at different stages of gestation: 5 cases before 28weeks, , 7 cases between 28-32 weeks, and 25 cases beyond 32 weeks. Univariate analysis revealed that the incidence of ICP in pregnant women with twin pregnancies was significantly associated with a personal or family history of ICP, pre-pregnancy Body Mass Index(BMI) and weight gain during pregnancy (P<0.05). Moreover, weight gain was identified as an independent risk factor for ICP in twin pregnancies (P<0.05); The ICP group showed significantly higher rates of fetal distress (21.62%), meconium-stained amniotic fluid (13.51%), premature birth (35.14%) and transfer to the Neonatal Intensive Care UnitNICU (24.32%) compared to the non-ICP group (P<0.05). However, there was no significant difference in the incidence of aspiration pneumonia and neonatal death between the two groups (P>0.05); The levels of serum TBA (23.49±12.91 μmol/L) , ALT (71.01±61.04 U/L), AST (68.25±56.37 U/L), TBil (12.17±5.44 μmol/L) and LDL-C (4.67±1.44 mmol/L) in the ICP group were elevated compared to the non-ICP group, Conversely, HDL-C level (1.77±0.39 mmol/L) was lower in the ICP group (P<0.05).Conclusion The incidence of ICP in women with twin pregnancies is notably high, Key influencing factors include a personal or family history of ICP, pre-pregnancy BMI, and increased weight gain during pregnancy. Additionally, the presence of ICP significantly elevates the risk of complications such as fetal distress, meconium-stained amniotic fluid, preterm birth and the need for transfer to the NICU.

Key words: Twin pregnancies, Pregnant women, Intrahepatic cholestasis, Risk factors, Neonatal outcome