The role of autotaxin in pruritus and preterm labor in early-onset intrahepatic cholestasis of pregnancy

INTRODUCTION: Intrahepatic cholestasis of pregnancy (ICP) is a common pregnancy-specific disorder characterized by pruritus and elevated serum total bile acids (TBA), and is associated with adverse outcomes such as preterm birth. This study aimed to investigate the role of autotaxin (ATX) in ICP-related pruritus and preterm labor. METHODS: This prospective cohort study included 180 pregnant women (100 diagnosed with ICP and 80 healthy controls) recruited from the Affiliated Maternal and Child Health Care Hospital of Nantong University between 2024 and 2025. Serum TBA, ATX, pruritus scores, and other relevant biochemical markers were measured and compared between patients with ICP and controls. Perinatal outcomes, including gestational age at delivery, birth weight, and Apgar scores at 1 and 5 minutes, were recorded for all participants. We evaluated the association of ATX and TBA with pruritus scores and preterm delivery. Statistical analyses were performed using t-tests, regression models, and Mann–Whitney U tests, as appropriate. RESULTS: No demographic differences were observed between the two groups (p > 0.05). Patients with ICP exhibited significantly higher TBA, Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), ATX concentrations, and pruritus scores (p < 0.05). The median ATX level was 8.08 ng/mL in the ICP group versus 3.45 ng/mL in controls. Preterm delivery and lower birth weight were more prevalent among ICP patients (p < 0.05), while Apgar scores were similar (p > 0.05). Maternal serum ATX concentrations were positively associated with pruritus in ICP patients. Although TBA, ALT, and AST concentrations were higher in preterm ICP cases (p < 0.05), ATX concentrations did not differ between preterm and term deliveries in ICP patients (p > 0.05) and had no significant correlation with preterm birth (p > 0.05). CONCLUSION: In summary, serum ATX concentrations were increased in early-onset ICP, correlating positively with pruritus severity but not with preterm birth.