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Objective <p>To evaluate whether albumin-based inflammatory indices are associated with perinatal and neonatal outcomes in pregnancies complicated by intrahepatic cholestasis of pregnancy (ICP).</p> Methods <p>This retrospective comparative study included 277 pregnant women who delivered at a tertiary referral center between January 2020 and December 2025 (ICP, <i>n</i> = 90; controls, <i>n</i> = 187). Albumin-based inflammatory indices were calculated from routine laboratory parameters obtained during the week of delivery. Perinatal and neonatal outcomes were compared between groups. Within the ICP group, associations between inflammatory indices and adverse outcomes were evaluated, and multivariable logistic regression analysis was performed to identify independent predictors within the ICP group of neonatal intensive care unit (NICU) admission.</p> Results <p>Gestational age at delivery and neonatal birth weight were significantly lower in the ICP group, while rates of preterm birth, low birth weight, and NICU admission were significantly higher compared with controls. Albumin-based inflammatory indices did not differ significantly between groups. Within the ICP group, low birth weight (&lt; 2500&#xa0;g) was associated with higher NAR (<i>p</i> = 0.031), whereas LAR (<i>p</i> = 0.094) and MAR (<i>p</i> = 0.129) were not statistically significant. NICU admission was associated with higher leukocyte-to-albumin ratio (LAR) (<i>p</i> = 0.036), neutrophil-to-albumin ratio (NAR) (<i>p</i> = 0.032), and monocyte-to-albumin ratio (MAR) (<i>p</i> = 0.017) in univariable analyses. In multivariable logistic regression analysis, higher LAR (OR 1.818, 95% CI 1.026–3.223; <i>p</i> = 0.041) and preterm birth &lt; 37 weeks (OR 6.119, 95% CI 2.145–17.457; <i>p</i> = 0.001) remained independently associated with NICU admission. Exploratory ROC analysis performed within the ICP group demonstrated limited discriminatory performance for all evaluated indices, with modest accuracy observed for LAR (AUC = 0.67) and MAR (AUC = 0.65), whereas other indices, including NPAR (<i>p</i> = 0.455) and CAR (<i>p</i> = 0.065), showed poor and non-significant discriminatory performance.</p> Conclusion <p>Albumin-based inflammatory indices demonstrated limited overall clinical utility in pregnancies complicated by ICP. Among these indices, leukocyte-to-albumin ratio was associated with NICU admission, suggesting a possible association between leukocyte-related inflammatory burden and neonatal outcomes. However, this finding should be interpreted with caution given the limited discriminatory performance of the evaluated indices and the potential for residual confounding. Further prospective studies are needed to validate this observation.</p>

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Association of albumin-based inflammatory indices with adverse neonatal outcomes in intrahepatic cholestasis of pregnancy: a retrospective comparative study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月2日

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  • Sevil Cicek,
  • Bilge Kapudere,
  • Yasemin Beyza Kaya Parspancı,
  • Zehra Tavukcuoglu,
  • Berkay Soyupak,
  • Merve Amine Eyiceoglu,
  • Feyza Kutay Yılmaz,
  • Reyhan Ayaz

摘要

Objective

To evaluate whether albumin-based inflammatory indices are associated with perinatal and neonatal outcomes in pregnancies complicated by intrahepatic cholestasis of pregnancy (ICP).

Methods

This retrospective comparative study included 277 pregnant women who delivered at a tertiary referral center between January 2020 and December 2025 (ICP, n = 90; controls, n = 187). Albumin-based inflammatory indices were calculated from routine laboratory parameters obtained during the week of delivery. Perinatal and neonatal outcomes were compared between groups. Within the ICP group, associations between inflammatory indices and adverse outcomes were evaluated, and multivariable logistic regression analysis was performed to identify independent predictors within the ICP group of neonatal intensive care unit (NICU) admission.

Results

Gestational age at delivery and neonatal birth weight were significantly lower in the ICP group, while rates of preterm birth, low birth weight, and NICU admission were significantly higher compared with controls. Albumin-based inflammatory indices did not differ significantly between groups. Within the ICP group, low birth weight (< 2500 g) was associated with higher NAR (p = 0.031), whereas LAR (p = 0.094) and MAR (p = 0.129) were not statistically significant. NICU admission was associated with higher leukocyte-to-albumin ratio (LAR) (p = 0.036), neutrophil-to-albumin ratio (NAR) (p = 0.032), and monocyte-to-albumin ratio (MAR) (p = 0.017) in univariable analyses. In multivariable logistic regression analysis, higher LAR (OR 1.818, 95% CI 1.026–3.223; p = 0.041) and preterm birth < 37 weeks (OR 6.119, 95% CI 2.145–17.457; p = 0.001) remained independently associated with NICU admission. Exploratory ROC analysis performed within the ICP group demonstrated limited discriminatory performance for all evaluated indices, with modest accuracy observed for LAR (AUC = 0.67) and MAR (AUC = 0.65), whereas other indices, including NPAR (p = 0.455) and CAR (p = 0.065), showed poor and non-significant discriminatory performance.

Conclusion

Albumin-based inflammatory indices demonstrated limited overall clinical utility in pregnancies complicated by ICP. Among these indices, leukocyte-to-albumin ratio was associated with NICU admission, suggesting a possible association between leukocyte-related inflammatory burden and neonatal outcomes. However, this finding should be interpreted with caution given the limited discriminatory performance of the evaluated indices and the potential for residual confounding. Further prospective studies are needed to validate this observation.