Perinatal Outcomes of Monochorionic and Dichorionic Twin Pregnancies Complicated by Intrahepatic Cholestasis of Pregnancy: A 6-year Retrospective Cohort Study

Perinatal Outcomes of Monochorionic and Dichorionic Twin Pregnancies Complicated by Intrahepatic Cholestasis of Pregnancy: A 6-year Retrospective Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Article Perinatal Outcomes of Monochorionic and Dichorionic Twin Pregnancies Complicated by Intrahepatic Cholestasis of Pregnancy: A 6-year Retrospective Cohort Study Shuang Luo, Jiayi Mao, Li Wen, Ya Chen, Jiayin Li, Wenti You, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3926092/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Jul, 2025 Read the published version in Scientific Reports → Version 1 posted 10 You are reading this latest preprint version Abstract Introduction Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy-related liver disorder and may cause adverse perinatal outcomes. However, few studies have reported differences in perinatal outcomes of monochorionic and dichorionic twin pregnancies complicated by ICP. These perinatal outcomes were assessed with a retrospective cohort study. Methods This was a retrospective observational study of monochorionic and dichorionic twin pregnan-cies complicated by ICP. Cases were divided into the MCDA group and DCDA group, perinatal outcomes were compared, and predictors of adverse perinatal outcomes were evaluated. Results In total, 363 twin pregnancies complicated by ICP (93 monochorionic (MC), 270 dichorionic (DC)) were included. Compared with DC twin pregnancies, MC pregnancies were characterized by younger age, lower prepregnancy weight and lower prepregnancy body mass index (p<0.05). Delivery of MC twins was more likely to occur between 34 and 37 weeks, averaging 34.87±2.42 gestational weeks. Additionally, both twins A and B in the MC group weighed less than those in the DC group (p40 µmol/l (aOR=9.16, 95%CI:1.06, 30.93, p=0.029) was an independent risk factor for poor perinatal outcomes in MC twin pregnancies complicated by ICP, and TBIL>17.1 µmol/l (aOR=6.36, 95% CI: 1.63-24.92, p=0.008), AST>200 U/L (aOR=3.005, 95%CI: 1.32-6.87, p=0.009) and ALP>400 U/L (aOR=3.25, 95%CI: 1.12-9.45, p=0.031) were independent risk factors for adverse perinatal outcomes in DC twin pregnancies. Conclusions Our results suggest that some liver function biochemical indicators can predict poor foetal outcomes in twin pregnancies complicated by ICP. More focus is needed on the monitoring of predelivery liver functional biochemical indexes in pregnant women according to chorionicity complicated by ICP, to facilitate personalized antenatal management and improve neonatal outcomes. Health sciences/Risk factors Health sciences/Medical research/Outcomes research Health sciences/Health care/Disease prevention Health sciences/Health care/Prognosis Health sciences/Signs and symptoms/Comorbidities intrahepatic cholestasis of pregnancy (ICP) monochorionic dichorionic twin pregnancy retrospective study perinatal outcomes Figures Figure 1 Introduction Pregnancies complicated by intrahepatic cholestasis of pregnancy (ICP) are known to have an increased risk of perinatal complications. Adverse outcomes in ICP are associated with higher bile acid concentrations. Bile acids have been shown to cause vasoconstriction of human placental chorionic veins and myometrial sensitivity to oxytocin, and high maternal bile acid levels may lead to damage to placental structures and consequently decrease the delivery of oxygen and nutrients to the foetus[ 1 , 2 ]. Recent studies have shown a higher risk of adverse perinatal outcomes in women with severe ICP (i.e., in those with serum bile acids > 40 µmol/L), including spontaneous preterm labour, meconium-stained amniotic fluid, neonatal unit admission, intrauterine foetal death, and, among women with peak bile acid concentrations above 100 µmol/L, stillbirth[ 3 – 6 ]. The prevalence of ICP in twin pregnancies is approximately 20–25%[ 7 , 8 ], and it has been reported that perinatal outcomes associated with ICP in twin pregnancies are worse than those in singleton pregnancies[ 9 ]. Multiple gestation has also been found to be linked to the development of ICP, and complications of multiple pregnancy may be affected or compounded by the presence of ICP[ 10 ].One large retrospective study demonstrated increased risks of adverse perinatal outcomes in ICP twin pregnancies[ 11 ].The ICP incidence is higher among twin pregnancies (20–22%), which may be explained by elevated levels of progesterone and oestrogen in these pregnancies[ 11 ], but there have been only a few studies comparing perinatal outcomes of twin pregnancies with ICP based on chorionicity[ 8 , 12 ]. Monochorionic diamniotic (MCDA) and dichorionic diamniotic (DCDA) twin pregnancies are the two main types of twin pregnancies. Although some studies have explored the adverse perinatal outcomes in MCDA and DCDA twin pregnancies complicated by ICP, respectively[ 8 , 12 ], there is no literature comparing the perinatal outcomes of MC and DC twin pregnancies complicated by ICP. Therefore, we aimed to investigate and compare the perinatal outcomes of MC and DC twin pregnancies with ICP and to identify the predictors of adverse perinatal outcomes. These findings may be helpful for improving the clinical assessment and management of patients with ICP and for planning the delivery among patients with ICP in monochorionic and dichorionic twin pregnancies. Materials and methods Study design We conducted a retrospective cohort study of women who delivered at a large tertiary obstetric centre (Women and Children’s Hospital of Chongqing Medical University, CQMU-WCH) in Chongqing, China, from January 2017 to December 2022. CQMU-WCH is one of the largest maternity hospitals in Chongqing in terms of delivery volume, with 16 000 ~ 18 000 annual deliveries. All electronic medical records of eligible women were sys-tematically reviewed. The retrospective data were deidentified when relevant data were extracted. Study participants All patients who were referred to our institute were confirmed to have twin pregnancies, and chorionicity was verified by colour Doppler ultrasonography at 11 to 15 weeks of gestation. The exclusion criteria were undelivered, termination of pregnancy, artificial abortion, exploratory laparotomy, induction of labour or unknown chorionicity. After participant selection, a total of 363 twin pregnancies, including 93 MC twins and 270 DC twins, were included in the analyses (Fig. 1 ). Data collection All cases of ICP were confirmed by demonstration of serum TBA above 40 mmol/L in the second and third trimester of pregnancy, raised liver transaminase enzymes in association with pruritus, and no additional identifiable cause for the liver dysfunction. Patients were excluded if their pruritus could be attributed to causes other than ICP or if they had gallstones, cholecystitis, or liver cirrhosis. All patients were screened by lab tests for hepatitis virus infection, and all lab measurements were the last liver function test results before delivery.Data on maternal demographics, obstetric and medical history were collected for all women, and data on serum biochemistry,management, and monitoring were collected for the ICP cases. Gestational age was calculated with reference to the first-trimester ultrasound scan. First-trimester ultrasound examination was also used to determine chorionicity. Maternal complications, such as preeclampsia, pregnancy-induced hypertensive disorder, gestational diabetes mellitus, premature rupture of membranes, placenta previa, anaemia, placental abruption, postpartum haemorrhage, thrombocytopenia, hypoproteinaemia, pregnancy with hypothyroidism, polyhydramnios, abnormal umbilical cord, premature birth and caesarean delivery rate were recorded. The perinatal outcomes studied were low birth weight, neonatal intensive care unit admission, foetal distress, hyperbilirubinemia, neonatal anaemia, neonatal sepsis, lower gastrointestinal bleeding, hypoglycaemia, hypoproteinaemia, neonatal jaundice, metabolic acidosis, necrotizing enterocolitis, pneumonia, respiratory failure, patent foramen ovale, patent ductus arteriosus, selective intrauterine growth restriction and neonatal respiratory distress syndrome. Due to the various impacts of ICP on neonatal outcomes, composite adverse neonatal outcomes were used to evaluate the neonatal outcomes of ICP in previous studies[ 5 ]. A composite adverse neonatal outcome was created and defined as any of the following: neonatal intensive care unit admission, foetal distress, neonatal respiratory distress syndrome, respiratory failure, hyperbilirubinemia, and neonatal hypoglycaemia, among other adverse events. Statistical analyses The data were analysed using SPSS (IBM SPSS Statistics for Windows, version 26.0, IBM Corporation). Continuous variables with approximate Gaussian distributions are presented as the mean ± standard deviation and were analysed by Student’s t-test. The Wilcoxon rank-sum test was used for non-Gaussian distributions. Categorical variables are presented as frequencies and accompanying percentages and were analysed using the chi-squared test or Fisher's exact test. Crosstabs were performed for independent group comparisons with effect sizes (Cramer's V) reported when applicable. Independent risk factors were analysed and identified by logistic regression analyses, in which possible confounding factors (maternal age, gravidity, parity and conceiving method) were considered. Logistic regression was used to establish a relationship between adverse neonatal outcomes and maternal biochemical parameters (total bile acid [TBA], alanine transaminase [ALT], aspartate transaminase [AST], prealbumin [PA], total protein [TP], albumin [ALB], globulin [GLO], total bilirubin [TBIL], direct bilirubin [DBIL], indirect bilirubin [IBIL], alkaline phosphatase [ALP], gamma glutamyl transferase [GGT], lactic dehydrogenase [LDH]). A two-tailed p < 0.05 was considered statistically significant, and 95% confidence interval (CI) was used. Ethical approval This study was approved by the medical ethics committee of Chongqing Health Center for Women and Children (2022011, date of approval: January 1st 2022). Results The number of individuals at each stage of the study is presented in Figure 1. The study included 3768 pairs of twins, of which 587 were included due to ICP diagnosis, 47 were excluded due to repeated admission and 176 were excluded due to pre-existing liver function abnormalities or metabolic diseases before pregnancy. Therefore, during the study period, 363 twin pregnancies complicated by ICP were included and assessed for eligibility, of which 93 were MCDA twins and 270 were DCDA twins. The demographic characteristics of the study population are presented in Table 1. Compared with dichorionic twin pregnancies complicated by ICP, women in the monochorionic twin pregnancy group were younger (mean (SD) 29.80 (4.15) vs. 30.74 (3.80), p <0.05) and had a lower prepregnancy weight (mean (SD) 51.73 (6.91) vs. 54.95 (7.67), p<0.001) and prepregnancy BMI (mean (SD) 20.68 (2.39) vs. 21.82 (2.94), p<0.001). In addition, mothers of MCDA twin pregnancy complicated by ICP were more likely to deliver between 34 and 37 gestational weeks, at an average delivery gestational age of 34.87±2.42, and appeared to have significantly lower parity (95.70% vs. 80.37%, p<0.001). Moreover, the DCDA group had a significantly higher rate of IVF-ET than the MCDA group (64.07% vs. 36.56%, p<0.001). Table 1 Maternal demographic characteristics between MCDA and DCDA twin pregnancies complicated by ICP ［ (mean±SD)/n(%) ］ Variables MCDA(n = 93) DCDA(n = 270) Effect size (t/Cramer's V) P- value Age [years] 29.80±4.15 30.74±3.80 -2.018 0.044 Pre-pregnancy weight[kg] 51.73±6.91 54.95±7.67 -3.579 ＜0.001 Pre-pregnancy BMI 20.68±2.39 21.82±2.94 -3.684 ＜0.001 Weight gain in pregnancy [kg] 16.21±5.07 15.86±5.47 0.534 0.594 GA at delivery [weeks] 34.87±2.42 35.81±2.22 0.406 0.001 ≥37 weeks 16(17.20) 125(46.30) 0.307 ＜0.001 ≥34 weeks,<37 weeks 52(55.91) 108(40.00) ≥32 weeks,<34 weeks 19(20.43) 16(5.93) ＜32 6(6.45) 21(7.78) PPH[ml] 626.70±198.88 658.31±405.79 0.604 0.471 Yes 4(4.30) 13(4.81) 0.011 1.000 No 89(95.70) 257(95.19) Gravidity 1 36(38.71) 114(42.22) 0.031 0.553 ≥2 57 (61.29) 156(57.78) Parity 1 89(95.70) 217(80.37) 0.184 ＜0.001 ≥2 4(4.30) 53(19.63) Mode of conception IVF-ET 34(36.56) 173(64.07) 0.243 ＜0.001 SC 59(63.44) 97 (35.93) Mode of Delivery CS 90(96.77) 265(98.15) 0.041 0.685 VD 3(3.23) 5(1.85) MCDA:monochorionic-diamniotic;DCDA:dichorionic-diamniotic;GA:gestation age; PPH:postpartum hemorrhage;IVF-ET:In vitro fertilization-embryo transfer; CS:Cesarean section;SC:Spontaneous conception;VD:Vaginal delivery; BMI, body mass index;ICP:intrahepatic cholestasis of pregnancy.Pearson’s Chi-square test or Fisher’s exact test were used for categorical variables; Two independent sample t-tests were used for normally distributed variables. The obstetric outcomes of the included population are presented in Table 2. PTB occurred more frequently in the ICP-MCDA group than in the ICP-DCDA group (95.70% vs. 65.56%, p<0.001), while DCDA pregnancies complicated by ICP had significantly higher rates of hypoproteinaemia and pelvic inflammatory than the MCDA group (39.26% vs. 27.96%, p<0.05; 26.30% vs. 13.98%, p<0.05). Table 2 Obstetric outcomes between MCDA and DCDA twin pregnancies complicated by ICP ［ n(%) ］ Obstetric Outcomes MCDA (n=93) DCDA (n=270) Effect size (Cramer's V) P -value* OR (95% CI) PTB 89(95.70) 177(65.56) 0.297 ＜0.001 1.44(1.31,1.58) ICU 7(7.53) 9(3.33) 0.089 0.091 2.35(0.85,6.50) PROM 11(11.83) 47(17.41) 0.066 0.251 1.57(0.78,3.18) GDM 27(29.03) 91(33.70) 0.044 0.443 1.24(0.74,2.08) HDP 13(13.98) 28(10.37) 0.050 0.448 0.71(0.35,1.44) PE 14(15.05) 61(22.59) 0.081 0.121 1.64(0.87,3.11) Placenta previa 4(4.30) 15(5.56) 0.025 0.639 1.31(0.42,4.05) Anemia 43(46.24) 100(37.04) 0.082 0.140 0.68(0.43,1.10) Hypoproteinemia 26(27.96) 106(39.26) 0.103 0.032 1.67(1.10,2.79) Pelvic inflammatory 13(13.98) 71(26.30) 0.128 0.015 2.20(1.15,4.19) Placenta accreta 20(21.51) 56(20.74) 0.008 0.883 0.96(0.54,1.70) Placental abruption 1(1.08) 5(1.85) 0.027 0.612 1.74(0.20,15.05) sIUGR 4(4.30) 12(4.44) 0.003 1.000 1.04(0.33,3.29) PTB:premature birth;ICU:intensive care unit;HDP;hypertension disorders of pregnancy;PE:preeclampsia;PROM:prematureruptureofmembranes;GDM:gestational diabetes mellitus;ICP:intrahepatic cholestasis of pregnancy;sIUGR:selective intrauterine growth restriction;MCDA:monochorionic-diamniotic;DCDA:dichorionic-diamniotic;Chi-squared test for chorionicity comparisons;OR:Odds ratio;CI:confidence interval. The neonatal outcomes of MCDA and DCDA twin pregnancies complicated by ICP are presented in Table 3. Neonatal pneumonia and LBGI occurred more frequently in the MCDA group than in the DCDA group (6.99% vs. 1.30%, p<0.001; 6.99% vs. 3.15%, p=0.023), while the DCDA group had significantly higher rates of neonatal jaundice and hypokalaemia than the MCDA group (7.53% vs. 15.56%, p=0.006; 0.54% vs. 6.11%, p=0.002). Additionally, regarding neonatal BW, more than half of the new-borns in the MCDA group weighed between 1500 g~2500 g at birth (65.05% vs. 45.93%, p<0.001), and both twins A and B in the MCDA group seemed to weigh less than those in the DCDA group (p<0.001). Twin offspring delivered from monochorionic pregnancies had a lower mean BW (mean (SD) 2258.60 (496.41) vs. 2400.69 (500.49), 2155.75 (500.83) vs. 2360.07 (501.23), p<0.05) than those born from dichorionic pregnancies. Table 3 Neonatal outcomes between MCDA and DCDA pregnancies complicated by ICP ［ (mean±SD)/ n(%) ］ Neonatal outcomes MCDA(n=186) DCDA(n=540) Effect size (Cramer's V) P -value OR (95% CI) NICU admission 84(45.16) 288(53.33) 0.071 0.061 0.72(0.52,1.10) Stillbirth 3(1.61) 4(0.74) 0.039 0.294 2.20(0.49,9.91) Neonatal pneumonia 13(6.99) 7(1.30) 0.152 ＜0.001 0.18(0.70,0.45) Hyperbilirubinemia 33(17.74) 104(19.26) 0.017 0.648 1.11(0.72,1.71) neonatal jaundice 14(7.53) 84(15.56) 0.103 0.006 2.26(1.25,4.09) Hypokalemia 1(0.54) 33(6.11) 0.115 0.002 12.04(1.64,88.66) Hypoproteinemia 7(3.76) 31(5.74) 0.039 0.296 1.56(0.67,3.60) NRDS 15(8.06) 42(7.78) 0.005 0.900 0.96(0.52,1.78) Respiratory failure 17(9.14) 41(7.59) 0.025 0.502 0.82(0.45,1.48) PFO 30(16.13) 110(20.37) 0.047 0.206 1.33(0.85,2.07) PDA 10(5.38) 48(8.89) 0.057 0.128 1.72(0.85,3.47) LBGI 13(6.99) 17(3.15) 0.084 0.023 0.43(0.21,0.91) BDT 13(6.99) 50(9.26) 0.052 0.319 0.72(0.37,1.39) NEC 5(2.69) 18(3.33) 0.016 0.665 1.25(0.46,3.41) BW ≥2500 51(27.42) 254(47.04) 0.177 ＜0.001 - ≥1500g, <2500g 121(65.05) 248(45.93) ≥1000 g, <1500g 10(5.38) 27(5.00) ＜1000g 4(2.15) 11(2.04) twin A 2258.60±496.41 2400.69±500.49 -2.376 0.019 - twin B 2155.75±500.83 2360.07±501.23 -3.392 0.001 - MCDA:monochorionic-diamniotic;DCDA:dichorionic-diamniotic;ICP:intrahepatic cholestasis of pregnancy; BW:birth weight;NICU:neonatal intensive care center;NRDS:neonatal respiratory distress syndrome;PFO:patent foramen ovale; PDA:patent ductus arteriosis; LBGI: lower gastrointestinal bleeding; BDT:Birth weight discordance; NEC: Necrotizing enterocolitis;Chi-square test or Fisher’s exact test were used for categorical variables; Two independent sample t-tests were used for normally distributed variables; OR:Odds ratio;CI:confidence interval. The laboratory measurements of MCDA and DCDA twin pregnancies complicated by ICP are presented in Table 4. The data included in this analysis were the results of the last laboratory test before delivery. The concentrations of GLO, DBIL, TBA, ALT, AST, ALP, GGT, and LDH in the MCDA group were significantly higher than those in the DCDA group, while the levels of PA, ALB, and IBIL in the DCDA group were substantially higher than those in the MCDA group. Table 4 Laboratory measurements between MCDA and DCDA twin pregnancies complicated by ICP ［ (mean±SD)/median (IQR) ］ Laboratory measurements MCDA (n = 93) DCDA (n = 270) Effect size( t/U ) P - value* PA(mg/L) 158.70±35.29 179.33±40.27 -4.346 ＜0.001 TP(g/L) 60.65±5.15 60.67±5.08 -0.037 0.970 ALB(g/L) 30.18±3.64 31.53±3.10 -3.451 0.001 GLO(g/L) 30.68±3.49 29.12±3.47 3.718 ＜0.001 TBIL (μmol/L) 10.04±3.87 9.46±3.65 1.288 0.198 DBIL(μmol/L) 2.60(1.60,5.30) 1.60(1.10,2.40) -5.743 ＜0.001 IBIL(μmol/L) 6.55(5.10,7.65) 7.20(5.60,8.65) 3.198 0.001 TBA(μmol/L) 17.25(8.53,27.23) 5.90(3.50,9.60) -7.941 ＜0.001 ALT(U/L) 57.50(15.75,127.25) 13.00(10.00,22.00) -7.316 ＜0.001 AST(U/L) 47.00(22.00,100.50) 21.00(16.00,27.00) -7.538 ＜0.001 ALP(U/L) 231.00(171.50,278.25) 196.00(159.50,239.50) -2.812 0.005 GGT(U/L) 27.00(16.25,46.25) 15.00(9.50,25.00) -4.734 ＜0.001 LDH(U/L) 237.50(198.50,272.00) 192.00(172.50,224.00) -6.258 ＜0.001 MCDA:monochorionic-diamniotic;DCDA:dichorionic-diamniotic;ICP:intrahepatic cholestasis of pregnancy; SD:standard deviation; IQR:interquartile range(25th, 75th percentiles);TBA:total bile acid;ALT:Alanine transaminase;AST:Aspartate transaminase.PA: prealbumin;TP: total protein;ALB:albumin;GLO:globulin;TBIL:total bilirubin;DBIL:direct bilirubin; IBIL:indirect bilirubin;ALP: alkaline phosphatase;GGT:gamma-glutamyltransferase;LDH:lactic dehydrogenase.Two independent sample t-tests were used for normally distributed variables; The differences of non-normally distributed parameters were analyzed using Mann–Whitney U-test. The predictors of adverse composite neonatal outcomes between MCDA and DCDA twin pregnancies complicated by ICP are presented in Table 5. The risk factors for major perinatal outcomes are as follows. TBIL>17.1 µmol/l, DBIL>7 µmol/l and TBA > 40 µmol/l were related to composite adverse neonatal outcomes in the chi-square analysis, while TBA>40 µmol/l (aOR=9.16, 95% CI: 1.06, 30.93, p=0.029) was an independent risk factor in the binary logistic regression analysis for MCDA twin pregnancies complicated by ICP. TBIL>17.1 µmol/l, DBIL>7 µmol/l, IBIL>10 µmol/l, TBA>40 µmol/l, ALT>200 U/L, AST>200 U/L and ALP >400 U/L were associated with composite adverse neonatal outcomes in the chi-square analysis in the DCDA group, while TBIL>17.1 µmol/l (aOR=6.36, 95% CI: 1.63-24.92, p=0.008), AST> 200 U/L (aOR=3.005, 95% CI: 1.32-6.87, p=0.009) and ALP >400 U/L (aOR=3.25, 95% CI: 1.12-9.45, p=0.031) were independent risk factors in the binary regression analysis (Table 5). Table 5 Predictors of adverse composite neonatal outcomes between MCDA and DCDA twin pregnancies complicated by ICP MCDA C rude OR P OR 95% CI TBIL>17.1 umol/l 4.763 0.029 10.750 0.80,44.94 DBIL>7 umol/l 10.100 0.001 20.500 1.67,25.71 TBA > 40 umol/l 4.710 0.030 5.070 1.04,24.83 Binary logistic analysis β P aOR 95% CI TBA > 40 umol/l 3.020 0.029 9.160 1.06,30.93 DCDA Crude OR P OR 95% CI TBIL>17.1umol/l 11.830 0.001 8.860 2.03,30.57 DBIL>7 umol/l 4.330 0.037 5.140 0.93,28.26 IBIL>10 umol/l 6.770 0.009 4.190 1.32,13.32 TBA>40 umol/l 4.390 0.036 8.030 0.80,80.23 ALT> 200U/L 7.120 0.007 2.741 1.29,5.84 AST>200U/L 12.300 0.001 3.690 1.72,7.91 ALP>400U/L 5.560 0.021 3.030 1.17,9.36 Binary logistic analysis β P aOR 95% CI TBIL>17.1umol/l 1.850 0.008 6.360 1.63,24.92 AST>200U/L 1.100 0.009 3.005 1.32,6.87 ALP>400U/L 1.180 0.031 3.250 1.12,9.45 MCDA:monochorionic-diamniotic;DCDA:dichorionic-diamniotic; TBA:total bile acid; ALT:Alanine transaminase; AST:Aspartate transaminase; ALB:albumin;TBIL: total bilirubin;DBIL: direct bilirubin;IBIL:indirect bilirubin;ALP: alkaline phosphatase;Chi-square test or Fisher’s exact test were used for categorical variables. aOR(adjusted Odds ratio) means adjusted for maternal age, gravidity, parity and conceiving method; CI: confidence interval. Discussion Our study findings indicate that the concentrations of DBIL, TBA, ALT, AST, ALP, GGT, and LDH in the MCDA group were significantly higher than those in the DCDA group. Additionally, TBA level > 40 µmol/l was a risk factor only in monochorionic twin pregnancies after controlling for maternal age, prepregnancy BMI, gravidity, parity and conception method. In dichorionic twin pregnancies, TBIL level>17.1 µmol/l, AST level >200 U/L, and ALP level >400 U/L were associated with a higher risk of adverse neonatal outcomes after controlling for possible confounding factors. Interpretation of Study Findings and Comparison with Published Literature In comparison with singleton pregnancies, twin pregnancies tend to have an increased risk of maternal mortality and pregnancy-associated complications, such as GDM, HDP and PPH, with an earlier disease presentation and higher levels of maternal serum total bile acids[7]. Importantly, twin gestations have also been identified as being linked to the development of ICP[13], and adverse maternal and foetal outcomes were strongly associated with ICP in twin patients[10], which may be explained by elevated sex hormone levels; however, perinatal outcomes between MC and DC twin gestations complicated by ICP have rarely been reported. Interestingly, the concentrations of DBIL, TBA, ALT, AST, ALP, GGT, and LDH in the MC group were significantly higher than those in the DC group, and we have not yet found other corresponding research to explain these intriguing findings. However, it was noteworthy that neonatal pneumonia and LBGI occurred more frequently in MC twins than in DC twins and that twin offspring delivered from monochorionic pregnancies had a lower mean birth weight and higher proportion of deliveries occurring between 34 and 37 weeks of gestation than those born from dichorionic pregnancies. This may be relevant to the higher prenatal maternal liver function biochemical parameters resulting in iatrogenic premature delivery in MC twin pregnancies. Xu’s study also reported that most of the foetuses of twin pregnancies with ICP were born before 37 weeks[9]. Mei’s retrospective study provided evidence that for women with MC twin pregnancy with ICP, TBA>40 μmol/L was associated with adverse perinatal outcomes[12], which was similar to what we found. The severity of hypercholanaemia is associated with adverse foetal outcomes, such as stillbirth, when maternal TBA concentrations exceed 40 μmol/L, and the association is markedly evident at ≥100 μmol/L[4,5]. TBA can be transported through the placenta and is involved in uterine-placental foetal circulation[14]. Studies have demonstrated an association between higher maternal bile acid levels and increased rates of foetal complications, particularly when serum bile acids are raised above 40 μmol/L[6]. Elevated TBA could increase oxytocin sensitivity of uterine muscle and cause vasoconstriction disorders in the placental chorionic vessels and umbilical vein, which could be a factor in the increased risk of foetal distress, asphyxia and stillbirth in ICP[15-17], especially when a placenta is shared in a MC twin pregnancy. It has been reported that bile acids are a key factor in the disruption of the structure of pulmonary surfactant in neonates from ICP pregnancies, and this has important implications for neonatal respiratory failure[18]. In addition, Mei's team also found that after adjusting for confounders, AST levels >200 U/L and ALP levels >400 U/L were associated with adverse perinatal outcomes in DC twin pregnancy complicated by ICP[8]. Our study had similar results to previous studies. Our study also indicated that TBIL levels exceeding 17.1 μmol/l were related to a higher risk of adverse neonatal outcomes in DC twin pregnancies, but we did not find similar results in MC twin pregnancies with ICP. Serum TBIL can reflect the early stage of intrahepatic cholestasis in pregnant women. TBIL is the combination of direct and indirect bilirubin. A sharp increase in the DBIL level often indicates the occurrence of obstructive jaundice so that it cannot be discharged from the biliary tract smoothly and can only enter the blood circulation, causing the serum TBIL to be at a high level. Elevated bilirubin can inhibit oxidative phosphorylation in nerve cells, reduce ATP production and increase the cytotoxicity of bile acids. However, data on the relationship between elevated total bilirubin levels and perinatal outcomes are inadequate in the previous literature. Although the mechanism is unclear, DC twin pregnancies with elevated AST, ALP and TBIL require intensified surveillance and management based on our results. Clinical and Research Implications ICP affected foetal outcomes, and when chorionicity was taken into consideration, although there was no difference in the incidence of neonatal stillbirth between the two groups, TBA>40 μmol/L was an independent risk factor for adverse perinatal outcomes in MC pregnancies, while TBIL level>17.1 µmol/l, AST level >200 U/L and ALP level >400 U/L were associated with a higher risk of adverse neonatal outcomes in dichorionic pregnancies. In addition, the serum biochemistry concentrations of DBIL, TBA, ALT, AST, ALP, GGT, and LDH in the MC group seemed to be apparently higher than those in the DC group. Evidence in previous literature is very limited regarding comparing the neonatal outcomes of monochorionic and dichorionic twin pregnancies complicated by ICP. Our findings indicated that monitoring predelivery liver function biochemical indexes in pregnant women according to chorionicity might facilitate personalized antenatal management to balance the iatrogenic prematurity risk and improve neonatal outcomes. Strengths and Limitations To our knowledge, this study is the first to compare the neonatal outcomes of monochorionic and dichorionic twin pregnancies complicated by ICP. The main strength was that we analysed the predictors of adverse outcomes in different chorionic twins. This result may help providers when they make delivery plans for patients with ICP in monochorionic and dichorionic twin pregnancies. In addition, we excluded twin pregnancies complicated by TTTS, TAPS and TRAPS to reduce bias in the assessment of neonatal outcomes. Several limitations of this study should be mentioned. First, this study was a single-centre study, and because it was not entirely population based nationally, the findings do not have reference value for populations in other regions. The data should therefore be interpreted with care because a selection bias may have been introduced due to regional divergence, and multicentre studies with adequate power remain warranted. Second, our study was retrospective, and medical records rather than direct patient interviews were used to obtain the data. Several maternal variables were not fully documented. Conclusions In summary, our findings of a strong association between liver function biochemical indexes and poor foetal outcomes in monochorionic and dichorionic twin pregnancies support the current practice of close antenatal monitoring of ICP twin pregnancies. More focus should be paid to monitoring predelivery liver function biochemical indexes in pregnant women with different chorionic twins, which might facilitate personalized antenatal management to improve neonatal outcomes. Abbreviations MCDA monochorionic-diamniotic DCDA dichorionic-diamniotic ICP intrahepatic cholestasis of pregnancy TBA total bile acid ALT alanine transaminase AST aspartate transaminase PA prealbumin ALB albumin TBIL total bilirubin DBIL direct bilirubin IBIL indirect bilirubin ALP alkaline phosphatase OR Odds ratio CI confidence interval Declarations Acknowledgements We appreciated all the pregnant women who supported our study. Competing interests None. Funding This work was supported by Sichuan Science and Technology Program(Grant number: 2023YFQ0005). Ethics approval and consent to participate This study was approved by the medical ethics commit-tee of Chongqing Health Center for Women and Children (2022011).All information that can identify participants will not be disclosed. Consent for publication Patient consent was waived since the research subjects identity was not known to the researchers. Availability of data and materials The datasets generated and/or analyzed during the current study are not publicly available due to funding agreements, but aggerate datasets are available from the corresponding author on reasonable request. Authors’ contributions SL designed and conceptualized this study, collected, checked and analyzed the data, and drafted the manuscript. JY-M contributed to data collection and analysis, and made suggestions for manuscript revision. WT-Y,XY-H, JY-T and TH was responsible for the data management and acquisition. YC and QM-Z contributed to check the data and proposed suggestions on the study. LW and YC supervised this study, read and revised the entire manuscript critically. All authors have contributed to reading and approving the final manuscript. References Geenes,V.L.et al. A placental phenotype for intrahepatic cholestasis of pregnancy. Placenta. 2011;32(12):1026–1032. Du,P.Y. et al. Placental gene-expression profiles of intrahepatic cholestasis of pregnancy reveal involvement of multiple molecular pathways in blood vessel formation and inflammation. BMC Med Genomics. 2014;7:42. Herrera,C.A.et al. Perinatal outcomes associated with intrahepatic cholestasis of pregnancy. J Matern Fetal Neonatal Med. 2018;31(14):1913–1920. Ovadia,C. et al. Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. Lancet. 2019;393(10174):899–909. Kawakita,T. et al. Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy. Am J Obstet Gynecol. 2015;213(4):570.e1-e8. Geenes,V. et al. Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: a prospective population-based case-control study. Hepatology. 2014;59(4):1482–1491. Batsry,L.et al. Perinatal outcomes of intrahepatic cholestasis of pregnancy in twin versus singleton pregnancies: is plurality associated with adverse outcomes? Arch Gynecol Obstet. 2019;300(4):881–887. Mei,Y.et al. Predictors of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy with dichorionic diamniotic twin pregnancies.J Matern Fetal Neonatal Med. 2019;32(3):472–476. Xu,T. et al. Perinatal outcomes associated with ICP in twin pregnancies were worse than singletons: an almost 5-year retrospective cohort study. BMC Pregnancy Childbirth. 2022;22(1):820. Shan,D.et al. Intrahepatic Cholestasis of Pregnancy in Women With Twin Pregnancy. Twin Res Hum Genet. 2016;19(6):697–707. Liu,X.et al. Perinatal outcomes with intrahepatic cholestasis of pregnancy in twin pregnancies. J Matern Fetal Neonatal Med. 2016;29(13):2176–2181. Mei,Y. et al. Perinatal outcomes in intrahepatic cholestasis of pregnancy with monochorionic diamniotic twin pregnancy. BMC Pregnancy Childbirth.2018;18(1):291. Feng,C.et al. Impacts of different methods of conception on the perinatal outcome of intrahepatic cholestasis of pregnancy in twin pregnancies. Sci Rep. 2018;8(1):3985. Shan D, Dong R, Hu Y. Current understanding of autophagy in intrahepatic cholestasis of pregnancy. Placenta. 2021;115:53–59. William Goodnight RN. Optimal Nutrition for Improved Twin Pregnancy Outcome. OBSTETRICS & GYNECOLOGY. 2009;114(5):1121–1134. Williamson C, Geenes V. Intrahepatic cholestasis of pregnancy. Obstet Gynecol. 2014;124(1):120–133. Ozkan,S.et al. Review of a challenging clinical issue: Intrahepatic cholestasis of pregnancy. World J Gastroenterol.2015;21(23):7134–7141. Zhang,Y.et al. Maternal bile acid transporter deficiency promotes neonatal demise. Nat Commun. 2015;6:8186. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 17 Jul, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 02 Jul, 2024 Reviews received at journal 28 Jun, 2024 Reviews received at journal 12 Jun, 2024 Reviewers agreed at journal 05 Jun, 2024 Reviewers agreed at journal 01 Jun, 2024 Reviewers invited by journal 01 Apr, 2024 Editor assigned by journal 26 Mar, 2024 Editor invited by journal 15 Feb, 2024 Submission checks completed at journal 12 Feb, 2024 First submitted to journal 03 Feb, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3926092","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":272382855,"identity":"b0f2cbff-a2ca-4550-bf9b-d250ff373a63","order_by":0,"name":"Shuang Luo","email":"","orcid":"","institution":"Chongqing Health Center for Women and Children","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shuang","middleName":"","lastName":"Luo","suffix":""},{"id":272382856,"identity":"af01bc71-8564-413b-98c0-04ed7ac6a240","order_by":1,"name":"Jiayi Mao","email":"","orcid":"","institution":"Chongqing Health Center for Women and Children","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jiayi","middleName":"","lastName":"Mao","suffix":""},{"id":272382857,"identity":"a7d1ecc2-0eeb-48c7-8bf5-40dd8fc219a1","order_by":2,"name":"Li Wen","email":"","orcid":"","institution":"Chongqing Health Center for Women and Children","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Wen","suffix":""},{"id":272382858,"identity":"a8814f01-ff5f-4f45-85b4-553da2240335","order_by":3,"name":"Ya Chen","email":"","orcid":"","institution":"Chongqing Health Center for Women and Children","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ya","middleName":"","lastName":"Chen","suffix":""},{"id":272382859,"identity":"ae484107-94fe-4d4a-ba0e-94ae610adbba","order_by":4,"name":"Jiayin Li","email":"","orcid":"","institution":"Chongqing Health Center for Women and Children","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jiayin","middleName":"","lastName":"Li","suffix":""},{"id":272382860,"identity":"3e01b7f3-b03b-484c-a9e1-df744b51e42c","order_by":5,"name":"Wenti You","email":"","orcid":"","institution":"Chongqing Health Center for Women and Children","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wenti","middleName":"","lastName":"You","suffix":""},{"id":272382861,"identity":"93e04dd4-b955-48a0-baca-c95002abbae3","order_by":6,"name":"Yajun Yang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzElEQVRIiWNgGAWjYBACefaG9A8SFRJ2/OwNRGox7DnwjMHijEWyZM8BYq25kfiMobKlgnHDjQQidTDOSE57cLNBgpnh5uONNxhqbKIJamHneZZuOHOHBB/j7LRiC4ZjabkNBG1pz0mQljwjwcwsnWMmwdhwmLAWhgP5H6T/tkkwtkmeIVbLiYQ0CUmglh4JHiK1AAM52UDijESyBA/QLwnE+AUYlYkPJCrq7OyPH95440ONDREOQwIGEgmkKIdoIVXHKBgFo2AUjAwAABeAQSafz/8lAAAAAElFTkSuQmCC","orcid":"","institution":"Chongqing Health Center for Women and Children","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Yajun","middleName":"","lastName":"Yang","suffix":""}],"badges":[],"createdAt":"2024-02-04 03:44:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3926092/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3926092/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-09792-4","type":"published","date":"2025-07-17T16:05:10+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":51085063,"identity":"f2683744-597f-4671-b3cc-84902fa313f1","added_by":"auto","created_at":"2024-02-13 19:48:51","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":30849,"visible":true,"origin":"","legend":"\u003cp\u003eFlow-chart of the study with included and excluded cases described.MCMA:monochorionic-monoamnionic;MCDA:monochorionic-diamniotic;DCDA:dichorionic-diamniotic;ICP:intrahepatic cholestasis of pregnancy.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3926092/v1/f410f45a3e3db840f9e58cc6.png"},{"id":88506076,"identity":"a65795ca-a89e-43fb-b704-47171dae07d7","added_by":"auto","created_at":"2025-08-07 07:30:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1132213,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3926092/v1/5a85e8fe-c326-4474-aab6-533a01330c7e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Perinatal Outcomes of Monochorionic and Dichorionic Twin Pregnancies Complicated by Intrahepatic Cholestasis of Pregnancy: A 6-year Retrospective Cohort Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePregnancies complicated by intrahepatic cholestasis of pregnancy (ICP) are known to have an increased risk of perinatal complications. Adverse outcomes in ICP are associated with higher bile acid concentrations. Bile acids have been shown to cause vasoconstriction of human placental chorionic veins and myometrial sensitivity to oxytocin, and high maternal bile acid levels may lead to damage to placental structures and consequently decrease the delivery of oxygen and nutrients to the foetus[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Recent studies have shown a higher risk of adverse perinatal outcomes in women with severe ICP (i.e., in those with serum bile acids\u0026thinsp;\u0026gt;\u0026thinsp;40 \u0026micro;mol/L), including spontaneous preterm labour, meconium-stained amniotic fluid, neonatal unit admission, intrauterine foetal death, and, among women with peak bile acid concentrations above 100 \u0026micro;mol/L, stillbirth[\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe prevalence of ICP in twin pregnancies is approximately 20\u0026ndash;25%[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], and it has been reported that perinatal outcomes associated with ICP in twin pregnancies are worse than those in singleton pregnancies[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Multiple gestation has also been found to be linked to the development of ICP, and complications of multiple pregnancy may be affected or compounded by the presence of ICP[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].One large retrospective study demonstrated increased risks of adverse perinatal outcomes in ICP twin pregnancies[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].The ICP incidence is higher among twin pregnancies (20\u0026ndash;22%), which may be explained by elevated levels of progesterone and oestrogen in these pregnancies[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], but there have been only a few studies comparing perinatal outcomes of twin pregnancies with ICP based on chorionicity[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMonochorionic diamniotic (MCDA) and dichorionic diamniotic (DCDA) twin pregnancies are the two main types of twin pregnancies. Although some studies have explored the adverse perinatal outcomes in MCDA and DCDA twin pregnancies complicated by ICP, respectively[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], there is no literature comparing the perinatal outcomes of MC and DC twin pregnancies complicated by ICP. Therefore, we aimed to investigate and compare the perinatal outcomes of MC and DC twin pregnancies with ICP and to identify the predictors of adverse perinatal outcomes. These findings may be helpful for improving the clinical assessment and management of patients with ICP and for planning the delivery among patients with ICP in monochorionic and dichorionic twin pregnancies.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eWe conducted a retrospective cohort study of women who delivered at a large tertiary obstetric centre (Women and Children\u0026rsquo;s Hospital of Chongqing Medical University, CQMU-WCH) in Chongqing, China, from January 2017 to December 2022. CQMU-WCH is one of the largest maternity hospitals in Chongqing in terms of delivery volume, with 16 000\u0026thinsp;~\u0026thinsp;18 000 annual deliveries. All electronic medical records of eligible women were sys-tematically reviewed. The retrospective data were deidentified when relevant data were extracted.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy participants\u003c/h2\u003e \u003cp\u003eAll patients who were referred to our institute were confirmed to have twin pregnancies, and chorionicity was verified by colour Doppler ultrasonography at 11 to 15 weeks of gestation. The exclusion criteria were undelivered, termination of pregnancy, artificial abortion, exploratory laparotomy, induction of labour or unknown chorionicity. After participant selection, a total of 363 twin pregnancies, including 93 MC twins and 270 DC twins, were included in the analyses (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eAll cases of ICP were confirmed by demonstration of serum TBA above 40 mmol/L in the second and third trimester of pregnancy, raised liver transaminase enzymes in association with pruritus, and no additional identifiable cause for the liver dysfunction. Patients were excluded if their pruritus could be attributed to causes other than ICP or if they had gallstones, cholecystitis, or liver cirrhosis. All patients were screened by lab tests for hepatitis virus infection, and all lab measurements were the last liver function test results before delivery.Data on maternal demographics, obstetric and medical history were collected for all women, and data on serum biochemistry,management, and monitoring were collected for the ICP cases. Gestational age was calculated with reference to the first-trimester ultrasound scan. First-trimester ultrasound examination was also used to determine chorionicity. Maternal complications, such as preeclampsia, pregnancy-induced hypertensive disorder, gestational diabetes mellitus, premature rupture of membranes, placenta previa, anaemia, placental abruption, postpartum haemorrhage, thrombocytopenia, hypoproteinaemia, pregnancy with hypothyroidism, polyhydramnios, abnormal umbilical cord, premature birth and caesarean delivery rate were recorded. The perinatal outcomes studied were low birth weight, neonatal intensive care unit admission, foetal distress, hyperbilirubinemia, neonatal anaemia, neonatal sepsis, lower gastrointestinal bleeding, hypoglycaemia, hypoproteinaemia, neonatal jaundice, metabolic acidosis, necrotizing enterocolitis, pneumonia, respiratory failure, patent foramen ovale, patent ductus arteriosus, selective intrauterine growth restriction and neonatal respiratory distress syndrome. Due to the various impacts of ICP on neonatal outcomes, composite adverse neonatal outcomes were used to evaluate the neonatal outcomes of ICP in previous studies[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. A composite adverse neonatal outcome was created and defined as any of the following: neonatal intensive care unit admission, foetal distress, neonatal respiratory distress syndrome, respiratory failure, hyperbilirubinemia, and neonatal hypoglycaemia, among other adverse events.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analyses\u003c/h2\u003e \u003cp\u003eThe data were analysed using SPSS (IBM SPSS Statistics for Windows, version 26.0, IBM Corporation). Continuous variables with approximate Gaussian distributions are presented as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and were analysed by Student\u0026rsquo;s t-test. The Wilcoxon rank-sum test was used for non-Gaussian distributions. Categorical variables are presented as frequencies and accompanying percentages and were analysed using the chi-squared test or Fisher's exact test. Crosstabs were performed for independent group comparisons with effect sizes (Cramer's V) reported when applicable. Independent risk factors were analysed and identified by logistic regression analyses, in which possible confounding factors (maternal age, gravidity, parity and conceiving method) were considered. Logistic regression was used to establish a relationship between adverse neonatal outcomes and maternal biochemical parameters (total bile acid [TBA], alanine transaminase [ALT], aspartate transaminase [AST], prealbumin [PA], total protein [TP], albumin [ALB], globulin [GLO], total bilirubin [TBIL], direct bilirubin [DBIL], indirect bilirubin [IBIL], alkaline phosphatase [ALP], gamma glutamyl transferase [GGT], lactic dehydrogenase [LDH]). A two-tailed p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant, and 95% confidence interval (CI) was used.\u003c/p\u003e \u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the medical ethics committee of Chongqing Health Center for Women and Children (2022011, date of approval: January 1st 2022).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe number of individuals at each stage of the study is presented in Figure 1. The study included 3768 pairs of twins, of which 587 were included due to ICP diagnosis, 47 were excluded due to repeated admission and 176 were excluded due to pre-existing liver function abnormalities or metabolic diseases before pregnancy. Therefore, during the study period, 363 twin pregnancies complicated by ICP were included and assessed for eligibility, of which 93 were MCDA twins and 270 were DCDA twins.\u003c/p\u003e\n\u003cp\u003eThe demographic characteristics of the study population are presented in Table 1. Compared with dichorionic twin pregnancies complicated by ICP, women in the monochorionic twin pregnancy group were younger (mean (SD) 29.80 (4.15) vs. 30.74 (3.80), p \u0026lt;0.05) and had a lower prepregnancy weight (mean (SD) 51.73 (6.91) vs. 54.95 (7.67), p\u0026lt;0.001) and prepregnancy BMI (mean (SD) 20.68 (2.39) vs. 21.82 (2.94), p\u0026lt;0.001). In addition, mothers of MCDA twin pregnancy complicated by ICP were more likely to deliver between 34 and 37 gestational weeks, at an average delivery gestational age of 34.87\u0026plusmn;2.42, and appeared to have significantly lower parity (95.70% vs. 80.37%, p\u0026lt;0.001). Moreover, the DCDA group had a significantly higher rate of IVF-ET than the MCDA group (64.07% vs. 36.56%, p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 Maternal demographic characteristics between MCDA and DCDA twin pregnancies complicated by ICP\u003c/strong\u003e\u003cstrong\u003e［\u003c/strong\u003e\u003cstrong\u003e(mean\u0026plusmn;SD)/n(%)\u003c/strong\u003e\u003cstrong\u003e］\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"574\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.352530541012218%\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.32460732984293%\"\u003e\n \u003cp\u003eMCDA(n = 93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.32460732984293%\"\u003e\n \u003cp\u003eDCDA(n = 270)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.069808027923212%\"\u003e\n \u003cp\u003eEffect size \u003cem\u003e(t/Cramer\u0026apos;s V)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.92844677137871%\"\u003e\n \u003cp\u003e\u003cem\u003eP-\u003c/em\u003e \u003cem\u003evalue\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.352530541012218%\"\u003e\n \u003cp\u003eAge [years]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.32460732984293%\"\u003e\n \u003cp\u003e29.80\u0026plusmn;4.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.32460732984293%\"\u003e\n \u003cp\u003e30.74\u0026plusmn;3.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.069808027923212%\"\u003e\n \u003cp\u003e-2.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.92844677137871%\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.352530541012218%\"\u003e\n \u003cp\u003ePre-pregnancy weight[kg]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.32460732984293%\"\u003e\n \u003cp\u003e51.73\u0026plusmn;6.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.32460732984293%\"\u003e\n \u003cp\u003e54.95\u0026plusmn;7.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.069808027923212%\"\u003e\n \u003cp\u003e-3.579\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.92844677137871%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.352530541012218%\"\u003e\n \u003cp\u003ePre-pregnancy BMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.32460732984293%\"\u003e\n \u003cp\u003e20.68\u0026plusmn;2.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.32460732984293%\"\u003e\n \u003cp\u003e21.82\u0026plusmn;2.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.069808027923212%\"\u003e\n \u003cp\u003e-3.684\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.92844677137871%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.352530541012218%\"\u003e\n \u003cp\u003eWeight gain in pregnancy [kg]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.32460732984293%\"\u003e\n \u003cp\u003e16.21\u0026plusmn;5.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.32460732984293%\"\u003e\n \u003cp\u003e15.86\u0026plusmn;5.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.069808027923212%\"\u003e\n \u003cp\u003e0.534\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.92844677137871%\"\u003e\n \u003cp\u003e0.594\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.352530541012218%\"\u003e\n \u003cp\u003eGA at delivery [weeks]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.32460732984293%\"\u003e\n \u003cp\u003e34.87\u0026plusmn;2.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.32460732984293%\"\u003e\n \u003cp\u003e35.81\u0026plusmn;2.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.069808027923212%\"\u003e\n \u003cp\u003e0.406\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.92844677137871%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.352530541012218%\"\u003e\n \u003cp\u003e\u0026ge;37 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.32460732984293%\"\u003e\n \u003cp\u003e16(17.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.32460732984293%\"\u003e\n \u003cp\u003e125(46.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.069808027923212%\" rowspan=\"4\"\u003e\n \u003cp\u003e0.307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.92844677137871%\" rowspan=\"4\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.82825484764543%\"\u003e\n \u003cp\u003e\u0026ge;34 weeks,\u0026lt;37 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.085872576177284%\"\u003e\n \u003cp\u003e52(55.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.085872576177284%\"\u003e\n \u003cp\u003e108(40.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.82825484764543%\"\u003e\n \u003cp\u003e\u0026ge;32 weeks,\u0026lt;34 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.085872576177284%\"\u003e\n \u003cp\u003e19(20.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.085872576177284%\"\u003e\n \u003cp\u003e16(5.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.82825484764543%\"\u003e\n \u003cp\u003e＜32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.085872576177284%\"\u003e\n \u003cp\u003e6(6.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.085872576177284%\"\u003e\n \u003cp\u003e21(7.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.352530541012218%\"\u003e\n \u003cp\u003ePPH[ml]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.32460732984293%\"\u003e\n \u003cp\u003e626.70\u0026plusmn;198.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.32460732984293%\"\u003e\n \u003cp\u003e658.31\u0026plusmn;405.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.069808027923212%\"\u003e\n \u003cp\u003e0.604\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.92844677137871%\"\u003e\n \u003cp\u003e0.471\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.352530541012218%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.32460732984293%\"\u003e\n \u003cp\u003e4(4.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.32460732984293%\"\u003e\n \u003cp\u003e13(4.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.069808027923212%\" rowspan=\"2\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.92844677137871%\" rowspan=\"2\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.82825484764543%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.085872576177284%\"\u003e\n \u003cp\u003e89(95.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.085872576177284%\"\u003e\n \u003cp\u003e257(95.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.306620209059233%\"\u003e\n \u003cp\u003eGravidity\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.352530541012218%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.32460732984293%\"\u003e\n \u003cp\u003e36(38.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.32460732984293%\"\u003e\n \u003cp\u003e114(42.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.069808027923212%\" rowspan=\"2\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.92844677137871%\" rowspan=\"2\"\u003e\n \u003cp\u003e0.553\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.82825484764543%\"\u003e\n \u003cp\u003e\u0026ge;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.085872576177284%\"\u003e\n \u003cp\u003e57 (61.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.085872576177284%\"\u003e\n \u003cp\u003e156(57.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.352530541012218%\"\u003e\n \u003cp\u003eParity\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.352530541012218%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.32460732984293%\"\u003e\n \u003cp\u003e89(95.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.32460732984293%\"\u003e\n \u003cp\u003e217(80.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.069808027923212%\" rowspan=\"2\"\u003e\n \u003cp\u003e0.184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.92844677137871%\" rowspan=\"2\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.82825484764543%\"\u003e\n \u003cp\u003e\u0026ge;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.085872576177284%\"\u003e\n \u003cp\u003e4(4.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.085872576177284%\"\u003e\n \u003cp\u003e53(19.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.352530541012218%\"\u003e\n \u003cp\u003eMode of conception\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.352530541012218%\"\u003e\n \u003cp\u003eIVF-ET\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.32460732984293%\"\u003e\n \u003cp\u003e34(36.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.32460732984293%\"\u003e\n \u003cp\u003e173(64.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.069808027923212%\" rowspan=\"2\"\u003e\n \u003cp\u003e0.243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.92844677137871%\" rowspan=\"2\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.82825484764543%\"\u003e\n \u003cp\u003eSC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.085872576177284%\"\u003e\n \u003cp\u003e59(63.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.085872576177284%\"\u003e\n \u003cp\u003e97 (35.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.352530541012218%\"\u003e\n \u003cp\u003eMode of Delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.352530541012218%\"\u003e\n \u003cp\u003eCS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.32460732984293%\"\u003e\n \u003cp\u003e90(96.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.32460732984293%\"\u003e\n \u003cp\u003e265(98.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.069808027923212%\" rowspan=\"2\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.92844677137871%\" rowspan=\"2\"\u003e\n \u003cp\u003e0.685\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.82825484764543%\"\u003e\n \u003cp\u003eVD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.085872576177284%\"\u003e\n \u003cp\u003e3(3.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.085872576177284%\"\u003e\n \u003cp\u003e5(1.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\"\u003e\n \u003cp\u003eMCDA:monochorionic-diamniotic;DCDA:dichorionic-diamniotic;GA:gestation age; PPH:postpartum hemorrhage;IVF-ET:In vitro fertilization-embryo transfer; CS:Cesarean section;SC:Spontaneous conception;VD:Vaginal delivery; BMI, body mass index;ICP:intrahepatic cholestasis of pregnancy.Pearson\u0026rsquo;s Chi-square test or Fisher\u0026rsquo;s exact test were used for categorical variables; Two independent sample t-tests were used for normally distributed variables.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe obstetric outcomes of the included population are presented in Table 2. PTB occurred more frequently in the ICP-MCDA group than in the ICP-DCDA group (95.70% vs. 65.56%, p\u0026lt;0.001), while DCDA pregnancies complicated by ICP had significantly higher rates of hypoproteinaemia and pelvic inflammatory than the MCDA group (39.26% vs. 27.96%, p\u0026lt;0.05; 26.30% vs. 13.98%, p\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Obstetric outcomes between MCDA and DCDA twin pregnancies complicated by ICP\u003c/strong\u003e\u003cstrong\u003e［\u003c/strong\u003e\u003cstrong\u003en(%)\u003c/strong\u003e\u003cstrong\u003e］\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"557\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.6983842010772%\"\u003e\n \u003cp\u003eObstetric Outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.746858168761221%\"\u003e\n \u003cp\u003eMCDA (n=93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.00359066427289%\"\u003e\n \u003cp\u003eDCDA\u003c/p\u003e\n \u003cp\u003e(n=270)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.235188509874327%\"\u003e\n \u003cp\u003eEffect size\u003c/p\u003e\n \u003cp\u003e(Cramer\u0026apos;s V)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.926391382405745%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.389587073608617%\"\u003e\n \u003cp\u003eOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.6983842010772%\"\u003e\n \u003cp\u003ePTB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.746858168761221%\"\u003e\n \u003cp\u003e89(95.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.00359066427289%\"\u003e\n \u003cp\u003e177(65.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.235188509874327%\"\u003e\n \u003cp\u003e0.297\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.926391382405745%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.389587073608617%\"\u003e\n \u003cp\u003e1.44(1.31,1.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.6983842010772%\"\u003e\n \u003cp\u003eICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.746858168761221%\"\u003e\n \u003cp\u003e7(7.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.00359066427289%\"\u003e\n \u003cp\u003e9(3.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.235188509874327%\"\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.926391382405745%\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.389587073608617%\"\u003e\n \u003cp\u003e2.35(0.85,6.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.6983842010772%\"\u003e\n \u003cp\u003ePROM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.746858168761221%\"\u003e\n \u003cp\u003e11(11.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.00359066427289%\"\u003e\n \u003cp\u003e47(17.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.235188509874327%\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.926391382405745%\"\u003e\n \u003cp\u003e0.251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.389587073608617%\"\u003e\n \u003cp\u003e1.57(0.78,3.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.6983842010772%\"\u003e\n \u003cp\u003eGDM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.746858168761221%\"\u003e\n \u003cp\u003e27(29.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.00359066427289%\"\u003e\n \u003cp\u003e91(33.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.235188509874327%\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.926391382405745%\"\u003e\n \u003cp\u003e0.443\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.389587073608617%\"\u003e\n \u003cp\u003e1.24(0.74,2.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.6983842010772%\"\u003e\n \u003cp\u003eHDP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.746858168761221%\"\u003e\n \u003cp\u003e13(13.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.00359066427289%\"\u003e\n \u003cp\u003e28(10.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.235188509874327%\"\u003e\n \u003cp\u003e0.050\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.926391382405745%\"\u003e\n \u003cp\u003e0.448\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.389587073608617%\"\u003e\n \u003cp\u003e0.71(0.35,1.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.6983842010772%\"\u003e\n \u003cp\u003ePE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.746858168761221%\"\u003e\n \u003cp\u003e14(15.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.00359066427289%\"\u003e\n \u003cp\u003e61(22.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.235188509874327%\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.926391382405745%\"\u003e\n \u003cp\u003e0.121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.389587073608617%\"\u003e\n \u003cp\u003e1.64(0.87,3.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.6983842010772%\"\u003e\n \u003cp\u003ePlacenta previa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.746858168761221%\"\u003e\n \u003cp\u003e4(4.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.00359066427289%\"\u003e\n \u003cp\u003e15(5.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.235188509874327%\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.926391382405745%\"\u003e\n \u003cp\u003e0.639\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.389587073608617%\"\u003e\n \u003cp\u003e1.31(0.42,4.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.6983842010772%\"\u003e\n \u003cp\u003eAnemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.746858168761221%\"\u003e\n \u003cp\u003e43(46.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.00359066427289%\"\u003e\n \u003cp\u003e100(37.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.235188509874327%\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.926391382405745%\"\u003e\n \u003cp\u003e0.140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.389587073608617%\"\u003e\n \u003cp\u003e0.68(0.43,1.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.6983842010772%\"\u003e\n \u003cp\u003eHypoproteinemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.746858168761221%\"\u003e\n \u003cp\u003e26(27.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.00359066427289%\"\u003e\n \u003cp\u003e106(39.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.235188509874327%\"\u003e\n \u003cp\u003e0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.926391382405745%\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.389587073608617%\"\u003e\n \u003cp\u003e1.67(1.10,2.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.6983842010772%\"\u003e\n \u003cp\u003ePelvic inflammatory\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.746858168761221%\"\u003e\n \u003cp\u003e13(13.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.00359066427289%\"\u003e\n \u003cp\u003e71(26.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.235188509874327%\"\u003e\n \u003cp\u003e0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.926391382405745%\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.389587073608617%\"\u003e\n \u003cp\u003e2.20(1.15,4.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.6983842010772%\"\u003e\n \u003cp\u003ePlacenta accreta\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.746858168761221%\"\u003e\n \u003cp\u003e20(21.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.00359066427289%\"\u003e\n \u003cp\u003e56(20.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.235188509874327%\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.926391382405745%\"\u003e\n \u003cp\u003e0.883\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.389587073608617%\"\u003e\n \u003cp\u003e0.96(0.54,1.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.6983842010772%\"\u003e\n \u003cp\u003ePlacental abruption\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.746858168761221%\"\u003e\n \u003cp\u003e1(1.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.00359066427289%\"\u003e\n \u003cp\u003e5(1.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.235188509874327%\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.926391382405745%\"\u003e\n \u003cp\u003e0.612\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.389587073608617%\"\u003e\n \u003cp\u003e1.74(0.20,15.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.6983842010772%\"\u003e\n \u003cp\u003esIUGR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.746858168761221%\"\u003e\n \u003cp\u003e4(4.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.00359066427289%\"\u003e\n \u003cp\u003e12(4.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.235188509874327%\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.926391382405745%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.389587073608617%\"\u003e\n \u003cp\u003e1.04(0.33,3.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\"\u003e\n \u003cp\u003ePTB:premature birth;ICU:intensive care unit;HDP;hypertension disorders of pregnancy;PE:preeclampsia;PROM:prematureruptureofmembranes;GDM:gestational diabetes mellitus;ICP:intrahepatic cholestasis of pregnancy;sIUGR:selective intrauterine growth restriction;MCDA:monochorionic-diamniotic;DCDA:dichorionic-diamniotic;Chi-squared test for chorionicity comparisons;OR:Odds ratio;CI:confidence interval.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe neonatal outcomes of MCDA and DCDA twin pregnancies complicated by ICP are presented in Table 3. Neonatal pneumonia and LBGI occurred more frequently in the MCDA group than in the DCDA group (6.99% vs. 1.30%, p\u0026lt;0.001; 6.99% vs. 3.15%, p=0.023), while the DCDA group had significantly higher rates of neonatal jaundice and hypokalaemia than the MCDA group (7.53% vs. 15.56%, p=0.006; 0.54% vs. 6.11%, p=0.002). Additionally, regarding neonatal BW, more than half of the new-borns in the MCDA group weighed between 1500 g~2500 g at birth (65.05% vs. 45.93%, p\u0026lt;0.001), and both twins A and B in the MCDA group seemed to weigh less than those in the DCDA group (p\u0026lt;0.001). Twin offspring delivered from monochorionic pregnancies had a lower mean BW (mean (SD) 2258.60 (496.41) vs. 2400.69 (500.49), 2155.75 (500.83) vs. 2360.07 (501.23), p\u0026lt;0.05) than those born from dichorionic pregnancies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cstrong\u003eTable 3 Neonatal outcomes between MCDA and DCDA pregnancies complicated by ICP\u003c/strong\u003e\u003cstrong\u003e［\u003c/strong\u003e\u003cstrong\u003e(mean\u0026plusmn;SD)/ n(%)\u003c/strong\u003e\u003cstrong\u003e］\u003c/strong\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"621\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.829581993569132%\" rowspan=\"3\"\u003e\n \u003cp\u003eNeonatal outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\" rowspan=\"3\"\u003e\n \u003cp\u003eMCDA(n=186)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\" rowspan=\"3\"\u003e\n \u003cp\u003eDCDA(n=540)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.308681672025724%\" rowspan=\"3\"\u003e\n \u003cp\u003eEffect size\u003c/p\u003e\n \u003cp\u003e(Cramer\u0026apos;s V)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45016077170418%\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.327974276527332%\" rowspan=\"3\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003eOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"31\" style=\"width: 4.8309%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"NaN%\" height=\"31\" style=\"width: 4.8309%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"NaN%\" height=\"31\" style=\"width: 4.8309%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.829581993569132%\"\u003e\n \u003cp\u003eNICU admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e84(45.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e288(53.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.308681672025724%\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45016077170418%\"\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.327974276527332%\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.72(0.52,1.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"4\" style=\"width: 4.8309%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.829581993569132%\"\u003e\n \u003cp\u003eStillbirth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e3(1.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e4(0.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.308681672025724%\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45016077170418%\"\u003e\n \u003cp\u003e0.294\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.327974276527332%\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e2.20(0.49,9.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"4\" style=\"width: 4.8309%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.829581993569132%\"\u003e\n \u003cp\u003eNeonatal pneumonia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e13(6.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e7(1.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.308681672025724%\"\u003e\n \u003cp\u003e0.152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45016077170418%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.327974276527332%\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.18(0.70,0.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"4\" style=\"width: 4.8309%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.829581993569132%\"\u003e\n \u003cp\u003eHyperbilirubinemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e33(17.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e104(19.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.308681672025724%\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45016077170418%\"\u003e\n \u003cp\u003e0.648\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.327974276527332%\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e1.11(0.72,1.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"4\" style=\"width: 4.8309%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.829581993569132%\"\u003e\n \u003cp\u003eneonatal jaundice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e14(7.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e84(15.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.308681672025724%\"\u003e\n \u003cp\u003e0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45016077170418%\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.327974276527332%\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e2.26(1.25,4.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"4\" style=\"width: 4.8309%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.829581993569132%\"\u003e\n \u003cp\u003eHypokalemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e1(0.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e33(6.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.308681672025724%\"\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45016077170418%\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.327974276527332%\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e12.04(1.64,88.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"4\" style=\"width: 4.8309%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.829581993569132%\"\u003e\n \u003cp\u003eHypoproteinemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e7(3.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e31(5.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.308681672025724%\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45016077170418%\"\u003e\n \u003cp\u003e0.296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.327974276527332%\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e1.56(0.67,3.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"4\" style=\"width: 4.8309%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.829581993569132%\"\u003e\n \u003cp\u003eNRDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e15(8.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e42(7.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.308681672025724%\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45016077170418%\"\u003e\n \u003cp\u003e0.900\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.327974276527332%\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.96(0.52,1.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"4\" style=\"width: 4.8309%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.829581993569132%\"\u003e\n \u003cp\u003eRespiratory failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e17(9.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e41(7.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.308681672025724%\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45016077170418%\"\u003e\n \u003cp\u003e0.502\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.327974276527332%\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.82(0.45,1.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"4\" style=\"width: 4.8309%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.829581993569132%\"\u003e\n \u003cp\u003ePFO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e30(16.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e110(20.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.308681672025724%\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45016077170418%\"\u003e\n \u003cp\u003e0.206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.327974276527332%\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e1.33(0.85,2.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"4\" style=\"width: 4.8309%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.829581993569132%\"\u003e\n \u003cp\u003ePDA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e10(5.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e48(8.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.308681672025724%\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45016077170418%\"\u003e\n \u003cp\u003e0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.327974276527332%\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e1.72(0.85,3.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"4\" style=\"width: 4.8309%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.829581993569132%\"\u003e\n \u003cp\u003eLBGI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e13(6.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e17(3.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.308681672025724%\"\u003e\n \u003cp\u003e0.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45016077170418%\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.327974276527332%\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.43(0.21,0.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"4\" style=\"width: 4.8309%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.829581993569132%\"\u003e\n \u003cp\u003eBDT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e13(6.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e50(9.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.308681672025724%\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45016077170418%\"\u003e\n \u003cp\u003e0.319\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.327974276527332%\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e0.72(0.37,1.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"4\" style=\"width: 4.8309%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.829581993569132%\"\u003e\n \u003cp\u003eNEC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e5(2.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e18(3.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.308681672025724%\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45016077170418%\"\u003e\n \u003cp\u003e0.665\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.327974276527332%\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e1.25(0.46,3.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"4\" style=\"width: 4.8309%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.829581993569132%\"\u003e\n \u003cp\u003eBW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.308681672025724%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45016077170418%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.327974276527332%\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"4\" style=\"width: 4.8309%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.829581993569132%\"\u003e\n \u003cp\u003e\u0026ge;2500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e51(27.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e254(47.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.308681672025724%\" rowspan=\"4\"\u003e\n \u003cp\u003e0.177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45016077170418%\" rowspan=\"4\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.327974276527332%\" rowspan=\"4\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"4\" style=\"width: 4.8309%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.112994350282484%\"\u003e\n \u003cp\u003e\u0026ge;1500g, \u0026lt;2500g\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.943502824858758%\"\u003e\n \u003cp\u003e121(65.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.943502824858758%\"\u003e\n \u003cp\u003e248(45.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"4\" style=\"width: 4.8309%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.112994350282484%\"\u003e\n \u003cp\u003e\u0026ge;1000 g, \u0026lt;1500g\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.943502824858758%\"\u003e\n \u003cp\u003e10(5.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.943502824858758%\"\u003e\n \u003cp\u003e27(5.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"4\" style=\"width: 4.8309%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.112994350282484%\"\u003e\n \u003cp\u003e＜1000g\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.943502824858758%\"\u003e\n \u003cp\u003e4(2.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.943502824858758%\"\u003e\n \u003cp\u003e11(2.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"4\" style=\"width: 4.8309%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.829581993569132%\"\u003e\n \u003cp\u003etwin A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e2258.60\u0026plusmn;496.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e2400.69\u0026plusmn;500.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.308681672025724%\"\u003e\n \u003cp\u003e-2.376\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45016077170418%\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.327974276527332%\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"4\" style=\"width: 4.8309%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.829581993569132%\"\u003e\n \u003cp\u003etwin B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e2155.75\u0026plusmn;500.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.041800643086816%\"\u003e\n \u003cp\u003e2360.07\u0026plusmn;501.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.308681672025724%\"\u003e\n \u003cp\u003e-3.392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45016077170418%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.327974276527332%\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"4\" style=\"width: 4.8309%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\" rowspan=\"2\" style=\"width: 95.0081%;\"\u003e\n \u003cp\u003eMCDA:monochorionic-diamniotic;DCDA:dichorionic-diamniotic;ICP:intrahepatic cholestasis of pregnancy; BW:birth weight;NICU:neonatal intensive care center;NRDS:neonatal respiratory distress syndrome;PFO:patent foramen ovale; PDA:patent ductus arteriosis;\u003csup\u003e\u0026nbsp;\u003c/sup\u003eLBGI: lower gastrointestinal bleeding; BDT:Birth weight discordance; NEC: Necrotizing enterocolitis;Chi-square test or Fisher\u0026rsquo;s exact test were used for categorical variables; Two independent sample t-tests were used for normally distributed variables; OR:Odds ratio;CI:confidence interval.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"31\" style=\"width: 4.8309%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"NaN%\" height=\"31\" style=\"width: 4.8309%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe laboratory measurements of MCDA and DCDA twin pregnancies complicated by ICP are presented in Table 4. The data included in this analysis were the results of the last laboratory test before delivery. The concentrations of GLO, DBIL, TBA, ALT, AST, ALP, GGT, and LDH in the MCDA group were significantly higher than those in the DCDA group, while the levels of PA, ALB, and IBIL in the DCDA group were substantially higher than those in the MCDA group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 Laboratory measurements between MCDA and DCDA twin pregnancies complicated by ICP\u003c/strong\u003e\u003cstrong\u003e［\u003c/strong\u003e\u003cstrong\u003e(mean\u0026plusmn;SD)/median (IQR)\u003c/strong\u003e\u003cstrong\u003e］\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"617\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.142857142857146%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaboratory\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003emeasurements\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\" rowspan=\"2\"\u003e\n \u003cp\u003eMCDA\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(n = 93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\" rowspan=\"2\"\u003e\n \u003cp\u003eDCDA\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(n = 270)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.38961038961039%\" rowspan=\"2\"\u003e\n \u003cp\u003eEffect size(\u003cem\u003et/U\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.662337662337663%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e- value*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"31\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"NaN%\" height=\"31\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.142857142857146%\"\u003e\n \u003cp\u003ePA(mg/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\"\u003e\n \u003cp\u003e158.70\u0026plusmn;35.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\"\u003e\n \u003cp\u003e179.33\u0026plusmn;40.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.38961038961039%\"\u003e\n \u003cp\u003e-4.346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.662337662337663%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"4\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.142857142857146%\"\u003e\n \u003cp\u003eTP(g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\"\u003e\n \u003cp\u003e60.65\u0026plusmn;5.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\"\u003e\n \u003cp\u003e60.67\u0026plusmn;5.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.38961038961039%\"\u003e\n \u003cp\u003e-0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.662337662337663%\"\u003e\n \u003cp\u003e0.970\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"6\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.142857142857146%\"\u003e\n \u003cp\u003eALB(g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\"\u003e\n \u003cp\u003e30.18\u0026plusmn;3.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\"\u003e\n \u003cp\u003e31.53\u0026plusmn;3.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.38961038961039%\"\u003e\n \u003cp\u003e-3.451\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.662337662337663%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"6\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.142857142857146%\"\u003e\n \u003cp\u003eGLO(g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\"\u003e\n \u003cp\u003e30.68\u0026plusmn;3.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\"\u003e\n \u003cp\u003e29.12\u0026plusmn;3.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.38961038961039%\"\u003e\n \u003cp\u003e3.718\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.662337662337663%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"6\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.142857142857146%\"\u003e\n \u003cp\u003eTBIL\u0026nbsp;(\u0026mu;mol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\"\u003e\n \u003cp\u003e10.04\u0026plusmn;3.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\"\u003e\n \u003cp\u003e9.46\u0026plusmn;3.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.38961038961039%\"\u003e\n \u003cp\u003e1.288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.662337662337663%\"\u003e\n \u003cp\u003e0.198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"6\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.142857142857146%\"\u003e\n \u003cp\u003eDBIL(\u0026mu;mol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\"\u003e\n \u003cp\u003e2.60(1.60,5.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\"\u003e\n \u003cp\u003e1.60(1.10,2.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.38961038961039%\"\u003e\n \u003cp\u003e-5.743\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.662337662337663%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"6\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.142857142857146%\"\u003e\n \u003cp\u003eIBIL(\u0026mu;mol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\"\u003e\n \u003cp\u003e6.55(5.10,7.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\"\u003e\n \u003cp\u003e7.20(5.60,8.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.38961038961039%\"\u003e\n \u003cp\u003e3.198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.662337662337663%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"6\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.142857142857146%\"\u003e\n \u003cp\u003eTBA(\u0026mu;mol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\"\u003e\n \u003cp\u003e17.25(8.53,27.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\"\u003e\n \u003cp\u003e5.90(3.50,9.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.38961038961039%\"\u003e\n \u003cp\u003e-7.941\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.662337662337663%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"6\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.142857142857146%\"\u003e\n \u003cp\u003eALT(U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\"\u003e\n \u003cp\u003e57.50(15.75,127.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\"\u003e\n \u003cp\u003e13.00(10.00,22.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.38961038961039%\"\u003e\n \u003cp\u003e-7.316\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.662337662337663%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"6\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.142857142857146%\"\u003e\n \u003cp\u003eAST(U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\"\u003e\n \u003cp\u003e47.00(22.00,100.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\"\u003e\n \u003cp\u003e21.00(16.00,27.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.38961038961039%\"\u003e\n \u003cp\u003e-7.538\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.662337662337663%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"6\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.142857142857146%\"\u003e\n \u003cp\u003eALP(U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\"\u003e\n \u003cp\u003e231.00(171.50,278.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\"\u003e\n \u003cp\u003e196.00(159.50,239.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.38961038961039%\"\u003e\n \u003cp\u003e-2.812\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.662337662337663%\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"6\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.142857142857146%\"\u003e\n \u003cp\u003eGGT(U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\"\u003e\n \u003cp\u003e27.00(16.25,46.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\"\u003e\n \u003cp\u003e15.00(9.50,25.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.38961038961039%\"\u003e\n \u003cp\u003e-4.734\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.662337662337663%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"6\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.142857142857146%\"\u003e\n \u003cp\u003eLDH(U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\"\u003e\n \u003cp\u003e237.50(198.50,272.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.4025974025974%\"\u003e\n \u003cp\u003e192.00(172.50,224.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.38961038961039%\"\u003e\n \u003cp\u003e-6.258\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.662337662337663%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"6\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\"\u003e\n \u003cp\u003eMCDA:monochorionic-diamniotic;DCDA:dichorionic-diamniotic;ICP:intrahepatic cholestasis of pregnancy; SD:standard deviation; IQR:interquartile range(25th, 75th percentiles);TBA:total bile acid;ALT:Alanine transaminase;AST:Aspartate transaminase.PA:\u0026nbsp;prealbumin;TP:\u0026nbsp;total protein;ALB:albumin;GLO:globulin;TBIL:total bilirubin;DBIL:direct bilirubin; IBIL:indirect bilirubin;ALP:\u0026nbsp;alkaline phosphatase;GGT:gamma-glutamyltransferase;LDH:lactic dehydrogenase.Two independent sample t-tests were used for normally distributed variables; The differences of non-normally distributed parameters were analyzed using Mann\u0026ndash;Whitney U-test.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" height=\"44\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe predictors of adverse composite neonatal outcomes between MCDA and DCDA twin pregnancies complicated by ICP are presented in Table 5. The risk factors for major perinatal outcomes are as follows. TBIL\u0026gt;17.1 \u0026micro;mol/l, DBIL\u0026gt;7 \u0026micro;mol/l and TBA \u0026gt; 40 \u0026micro;mol/l were related to composite adverse neonatal outcomes in the chi-square analysis, while TBA\u0026gt;40 \u0026micro;mol/l (aOR=9.16, 95% CI: 1.06, 30.93, p=0.029) was an independent risk factor in the binary logistic regression analysis for MCDA twin pregnancies complicated by ICP. TBIL\u0026gt;17.1 \u0026micro;mol/l, DBIL\u0026gt;7 \u0026micro;mol/l, IBIL\u0026gt;10 \u0026micro;mol/l, TBA\u0026gt;40 \u0026micro;mol/l, ALT\u0026gt;200 U/L, AST\u0026gt;200 U/L and ALP \u0026gt;400 U/L were associated with composite adverse neonatal outcomes in the chi-square analysis in the DCDA group, while TBIL\u0026gt;17.1 \u0026micro;mol/l (aOR=6.36, 95% CI: 1.63-24.92, p=0.008), AST\u0026gt; 200 U/L (aOR=3.005, 95% CI: 1.32-6.87, p=0.009) and ALP \u0026gt;400 U/L (aOR=3.25, 95% CI: 1.12-9.45, p=0.031) were independent risk factors in the binary regression analysis (Table 5).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e5 \u0026nbsp;Predictors of adverse composite neonatal outcomes between MCDA and DCDA twin pregnancies complicated by ICP\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"513\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.546875%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCDA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.921875%\"\u003e\n \u003cp\u003e\u003cstrong\u003eC\u003c/strong\u003e\u003cstrong\u003erude OR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.28125%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e\u003cstrong\u003e95%\u003cem\u003eCI\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.546875%\"\u003e\n \u003cp\u003eTBIL\u0026gt;17.1 umol/l\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.921875%\"\u003e\n \u003cp\u003e4.763\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.28125%\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e10.750\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e0.80,44.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.546875%\"\u003e\n \u003cp\u003eDBIL\u0026gt;7 umol/l\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.921875%\"\u003e\n \u003cp\u003e10.100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.28125%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e20.500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e1.67,25.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.546875%\"\u003e\n \u003cp\u003eTBA \u0026gt; 40 umol/l\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.921875%\"\u003e\n \u003cp\u003e4.710\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.28125%\"\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e5.070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e1.04,24.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.546875%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBinary logistic analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.921875%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026beta;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.28125%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e\u003cstrong\u003eaOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e\u003cstrong\u003e95%\u003cem\u003eCI\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.546875%\"\u003e\n \u003cp\u003eTBA \u0026gt; 40 umol/l\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.921875%\"\u003e\n \u003cp\u003e3.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.28125%\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e9.160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e1.06,30.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.546875%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDCDA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.921875%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude OR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.28125%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e\u003cstrong\u003e95%\u003cem\u003eCI\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.546875%\"\u003e\n \u003cp\u003eTBIL\u0026gt;17.1umol/l\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.921875%\"\u003e\n \u003cp\u003e11.830\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.28125%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e8.860\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e2.03,30.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.546875%\"\u003e\n \u003cp\u003eDBIL\u0026gt;7 umol/l\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.921875%\"\u003e\n \u003cp\u003e4.330\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.28125%\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e5.140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e0.93,28.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.546875%\"\u003e\n \u003cp\u003eIBIL\u0026gt;10 umol/l\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.921875%\"\u003e\n \u003cp\u003e6.770\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.28125%\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e4.190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e1.32,13.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.546875%\"\u003e\n \u003cp\u003eTBA\u0026gt;40 umol/l\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.921875%\"\u003e\n \u003cp\u003e4.390\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.28125%\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e8.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e0.80,80.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.546875%\"\u003e\n \u003cp\u003eALT\u0026gt; 200U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.921875%\"\u003e\n \u003cp\u003e7.120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.28125%\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e2.741\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e1.29,5.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.546875%\"\u003e\n \u003cp\u003eAST\u0026gt;200U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.921875%\"\u003e\n \u003cp\u003e12.300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.28125%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e3.690\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e1.72,7.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.546875%\"\u003e\n \u003cp\u003eALP\u0026gt;400U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.921875%\"\u003e\n \u003cp\u003e5.560\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.28125%\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e3.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e1.17,9.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.546875%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBinary\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;logistic analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.921875%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026beta;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.28125%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e\u003cstrong\u003eaOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e\u003cstrong\u003e95%\u003cem\u003eCI\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.546875%\"\u003e\n \u003cp\u003eTBIL\u0026gt;17.1umol/l\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.921875%\"\u003e\n \u003cp\u003e1.850\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.28125%\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e6.360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e1.63,24.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.546875%\"\u003e\n \u003cp\u003eAST\u0026gt;200U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.921875%\"\u003e\n \u003cp\u003e1.100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.28125%\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e3.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e1.32,6.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.546875%\"\u003e\n \u003cp\u003eALP\u0026gt;400U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.921875%\"\u003e\n \u003cp\u003e1.180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.28125%\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e3.250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e1.12,9.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\"\u003e\n \u003cp\u003eMCDA:monochorionic-diamniotic;DCDA:dichorionic-diamniotic; TBA:total bile acid; ALT:Alanine transaminase; AST:Aspartate transaminase; ALB:albumin;TBIL: total bilirubin;DBIL: direct bilirubin;IBIL:indirect bilirubin;ALP:\u0026nbsp;alkaline phosphatase;Chi-square test or Fisher\u0026rsquo;s exact test were used for categorical variables. aOR(adjusted Odds ratio) means adjusted for maternal age, gravidity, parity and conceiving method; CI: confidence interval.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study findings indicate that the concentrations of DBIL, TBA, ALT, AST, ALP, GGT, and LDH in the MCDA group were significantly higher than those in the DCDA group. Additionally, TBA level \u0026gt; 40 \u0026micro;mol/l was a risk factor only in monochorionic twin pregnancies after controlling for maternal age, prepregnancy BMI, gravidity, parity and conception method. In dichorionic twin pregnancies, TBIL level\u0026gt;17.1 \u0026micro;mol/l, AST level \u0026gt;200 U/L, and ALP level \u0026gt;400 U/L were associated with a higher risk of adverse neonatal outcomes after controlling for possible confounding factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eInterpretation of Study Findings and Comparison with Published Literature\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn comparison with singleton pregnancies, twin pregnancies tend to have an increased risk of maternal mortality and pregnancy-associated complications, such as GDM, HDP and PPH, with an earlier disease presentation and higher levels of maternal serum total bile acids[7]. Importantly, twin gestations have also been identified as being linked to the development of ICP[13], and adverse maternal and foetal outcomes were strongly associated with ICP in twin patients[10], which may be explained by elevated sex hormone levels; however, perinatal outcomes between MC and DC twin gestations complicated by ICP have rarely been reported.\u003c/p\u003e\n\u003cp\u003eInterestingly, the concentrations of DBIL, TBA, ALT, AST, ALP, GGT, and LDH in the MC group were significantly higher than those in the DC group, and we have not yet found other corresponding research to explain these intriguing findings. However, it was noteworthy that neonatal pneumonia and LBGI occurred more frequently in MC twins than in DC twins and that twin offspring delivered from monochorionic pregnancies had a lower mean birth weight and higher proportion of deliveries occurring between 34 and 37 weeks of gestation than those born from dichorionic pregnancies. This may be relevant to the higher prenatal maternal liver function biochemical parameters resulting in iatrogenic premature delivery in MC twin pregnancies. Xu\u0026rsquo;s study also reported that most of the foetuses of twin pregnancies with ICP were born before 37 weeks[9]. Mei\u0026rsquo;s retrospective study provided evidence that for women with MC twin pregnancy with ICP, TBA\u0026gt;40 \u0026mu;mol/L was associated with adverse perinatal outcomes[12], which was similar to what we found. The severity of hypercholanaemia is associated with adverse foetal outcomes, such as stillbirth, when maternal TBA concentrations exceed 40 \u0026mu;mol/L, and the association is markedly evident at \u0026ge;100 \u0026mu;mol/L[4,5]. TBA can be transported through the placenta and is involved in uterine-placental foetal circulation[14]. Studies have demonstrated an association between higher maternal bile acid levels and increased rates of foetal complications, particularly when serum bile acids are raised above 40 \u0026mu;mol/L[6]. Elevated TBA could increase oxytocin sensitivity of uterine muscle and cause vasoconstriction disorders in the placental chorionic vessels and umbilical vein, which could be a factor in the increased risk of foetal distress, asphyxia and stillbirth in ICP[15-17], especially when a placenta is shared in a MC twin pregnancy. It has been reported that bile acids are a key factor in the disruption of the structure of pulmonary surfactant in neonates from ICP pregnancies, and this has important implications for neonatal respiratory failure[18].\u003c/p\u003e\n\u003cp\u003eIn addition, Mei\u0026apos;s team also found that after adjusting for confounders, AST levels \u0026gt;200 U/L and ALP levels \u0026gt;400 U/L were associated with adverse perinatal outcomes in DC twin pregnancy complicated by ICP[8]. Our study had similar results to previous studies. Our study also indicated that TBIL levels exceeding 17.1 \u0026mu;mol/l were related to a higher risk of adverse neonatal outcomes in DC twin pregnancies, but we did not find similar results in MC twin pregnancies with ICP. Serum TBIL can reflect the early stage of intrahepatic cholestasis in pregnant women. TBIL is the combination of direct and indirect bilirubin. A sharp increase in the DBIL level often indicates the occurrence of obstructive jaundice so that it cannot be discharged from the biliary tract smoothly and can only enter the blood circulation, causing the serum TBIL to be at a high level. Elevated bilirubin can inhibit oxidative phosphorylation in nerve cells, reduce ATP production and increase the cytotoxicity of bile acids. However, data on the relationship between elevated total bilirubin levels and perinatal outcomes are inadequate in the previous literature. Although the mechanism is unclear, DC twin pregnancies with elevated AST, ALP and TBIL require intensified surveillance and management based on our results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eClinical and Research Implications\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eICP affected foetal outcomes, and when chorionicity was taken into consideration, although there was no difference in the incidence of neonatal stillbirth between the two groups, TBA\u0026gt;40 \u0026mu;mol/L was an independent risk factor for adverse perinatal outcomes in MC pregnancies, while TBIL level\u0026gt;17.1 \u0026micro;mol/l, AST level \u0026gt;200 U/L and ALP level \u0026gt;400 U/L were associated with a higher risk of adverse neonatal outcomes in dichorionic pregnancies. In addition, the serum biochemistry concentrations of DBIL, TBA, ALT, AST, ALP, GGT, and LDH in the MC group seemed to be apparently higher than those in the DC group. Evidence in previous literature is very limited regarding comparing the neonatal outcomes of monochorionic and dichorionic twin pregnancies complicated by ICP. Our findings indicated that monitoring predelivery liver function biochemical indexes in pregnant women according to chorionicity might facilitate personalized antenatal management to balance the iatrogenic prematurity risk and improve neonatal outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStrengths and Limitations\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo our knowledge, this study is the first to compare the neonatal outcomes of monochorionic and dichorionic twin pregnancies complicated by ICP. The main strength was that we analysed the predictors of adverse outcomes in different chorionic twins. This result may help providers when they make delivery plans for patients with ICP in monochorionic and dichorionic twin pregnancies. In addition, we excluded twin pregnancies complicated by TTTS, TAPS and TRAPS to reduce bias in the assessment of neonatal outcomes. Several limitations of this study should be mentioned. First, this study was a single-centre study, and because it was not entirely population based nationally, the findings do not have reference value for populations in other regions. The data should therefore be interpreted with care because a selection bias may have been introduced due to regional divergence, and multicentre studies with adequate power remain warranted. Second, our study was retrospective, and medical records rather than direct patient interviews were used to obtain the data. Several maternal variables were not fully documented.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn summary, our findings of a strong association between liver function biochemical indexes and poor foetal outcomes in monochorionic and dichorionic twin pregnancies support the current practice of close antenatal monitoring of ICP twin pregnancies. More focus should be paid to monitoring predelivery liver function biochemical indexes in pregnant women with different chorionic twins, which might facilitate personalized antenatal management to improve neonatal outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eMCDA \u0026nbsp; monochorionic-diamniotic\u003c/p\u003e\n\u003cp\u003eDCDA \u0026nbsp; dichorionic-diamniotic\u003c/p\u003e\n\u003cp\u003eICP \u0026nbsp; \u0026nbsp; \u0026nbsp;intrahepatic cholestasis of pregnancy\u003c/p\u003e\n\u003cp\u003eTBA \u0026nbsp; \u0026nbsp; total bile acid\u003c/p\u003e\n\u003cp\u003eALT \u0026nbsp; \u0026nbsp; alanine transaminase\u003c/p\u003e\n\u003cp\u003eAST \u0026nbsp; \u0026nbsp; aspartate transaminase\u003c/p\u003e\n\u003cp\u003ePA \u0026nbsp; \u0026nbsp; \u0026nbsp;prealbumin\u003c/p\u003e\n\u003cp\u003eALB \u0026nbsp; \u0026nbsp; albumin\u003c/p\u003e\n\u003cp\u003eTBIL \u0026nbsp; \u0026nbsp;total bilirubin\u003c/p\u003e\n\u003cp\u003eDBIL \u0026nbsp; \u0026nbsp;direct bilirubin\u003c/p\u003e\n\u003cp\u003eIBIL \u0026nbsp; \u0026nbsp; indirect bilirubin\u003c/p\u003e\n\u003cp\u003eALP \u0026nbsp; \u0026nbsp; alkaline phosphatase\u003c/p\u003e\n\u003cp\u003eOR \u0026nbsp; \u0026nbsp; \u0026nbsp;Odds ratio\u003c/p\u003e\n\u003cp\u003eCI \u0026nbsp; \u0026nbsp; \u0026nbsp;confidence interval\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe appreciated all the pregnant women who supported our study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by Sichuan Science and Technology Program(Grant number: 2023YFQ0005).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the medical ethics commit-tee of Chongqing Health Center for Women and Children (2022011).All information that can identify participants will not be disclosed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatient consent was waived since the research subjects identity was not known to the researchers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to funding agreements, but aggerate datasets are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSL designed and conceptualized this study, collected, checked and analyzed the data, and drafted the manuscript. JY-M contributed to data collection and analysis, and made suggestions for manuscript revision. WT-Y,XY-H, JY-T and TH was responsible for the data management and acquisition. YC and QM-Z contributed to check the data and proposed suggestions on the study. LW and YC supervised this study, read and revised the entire manuscript critically. All authors have contributed to reading and approving the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGeenes,V.L.et al. A placental phenotype for intrahepatic cholestasis of pregnancy. Placenta. 2011;32(12):1026\u0026ndash;1032.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDu,P.Y. et al. Placental gene-expression profiles of intrahepatic cholestasis of pregnancy reveal involvement of multiple molecular pathways in blood vessel formation and inflammation. BMC Med Genomics. 2014;7:42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHerrera,C.A.et al. Perinatal outcomes associated with intrahepatic cholestasis of pregnancy. J Matern Fetal Neonatal Med. 2018;31(14):1913\u0026ndash;1920.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOvadia,C. et al. Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. Lancet. 2019;393(10174):899\u0026ndash;909.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKawakita,T. et al. Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy. Am J Obstet Gynecol. 2015;213(4):570.e1-e8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGeenes,V. et al. Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: a prospective population-based case-control study. Hepatology. 2014;59(4):1482\u0026ndash;1491.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBatsry,L.et al. Perinatal outcomes of intrahepatic cholestasis of pregnancy in twin versus singleton pregnancies: is plurality associated with adverse outcomes? Arch Gynecol Obstet. 2019;300(4):881\u0026ndash;887.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMei,Y.et al. Predictors of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy with dichorionic diamniotic twin pregnancies.J Matern Fetal Neonatal Med. 2019;32(3):472\u0026ndash;476.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu,T. et al. Perinatal outcomes associated with ICP in twin pregnancies were worse than singletons: an almost 5-year retrospective cohort study. BMC Pregnancy Childbirth. 2022;22(1):820.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShan,D.et al. Intrahepatic Cholestasis of Pregnancy in Women With Twin Pregnancy. Twin Res Hum Genet. 2016;19(6):697\u0026ndash;707.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu,X.et al. Perinatal outcomes with intrahepatic cholestasis of pregnancy in twin pregnancies. J Matern Fetal Neonatal Med. 2016;29(13):2176\u0026ndash;2181.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMei,Y. et al. Perinatal outcomes in intrahepatic cholestasis of pregnancy with monochorionic diamniotic twin pregnancy. BMC Pregnancy Childbirth.2018;18(1):291.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFeng,C.et al. Impacts of different methods of conception on the perinatal outcome of intrahepatic cholestasis of pregnancy in twin pregnancies. Sci Rep. 2018;8(1):3985.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShan D, Dong R, Hu Y. Current understanding of autophagy in intrahepatic cholestasis of pregnancy. Placenta. 2021;115:53\u0026ndash;59.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliam Goodnight RN. Optimal Nutrition for Improved Twin Pregnancy Outcome. OBSTETRICS \u0026amp; GYNECOLOGY. 2009;114(5):1121\u0026ndash;1134.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliamson C, Geenes V. Intrahepatic cholestasis of pregnancy. Obstet Gynecol. 2014;124(1):120\u0026ndash;133.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOzkan,S.et al. Review of a challenging clinical issue: Intrahepatic cholestasis of pregnancy. World J Gastroenterol.2015;21(23):7134\u0026ndash;7141.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang,Y.et al. Maternal bile acid transporter deficiency promotes neonatal demise. Nat Commun. 2015;6:8186.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"intrahepatic cholestasis of pregnancy (ICP), monochorionic, dichorionic, twin pregnancy, retrospective study, perinatal outcomes","lastPublishedDoi":"10.21203/rs.3.rs-3926092/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3926092/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction \u003c/strong\u003eIntrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy-related liver disorder and may cause adverse perinatal outcomes. However, few studies have reported differences in perinatal outcomes of monochorionic and dichorionic twin pregnancies complicated by ICP. These perinatal outcomes were assessed with a retrospective cohort study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003eThis was a retrospective observational study of monochorionic and dichorionic twin pregnan-cies complicated by ICP. Cases were divided into the MCDA group and DCDA group, perinatal outcomes were compared, and predictors of adverse perinatal outcomes were evaluated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eIn total, 363 twin pregnancies complicated by ICP (93 monochorionic (MC), 270 dichorionic (DC)) were included. Compared with DC twin pregnancies, MC pregnancies were characterized by younger age, lower prepregnancy weight and lower prepregnancy body mass index (p\u0026lt;0.05). Delivery of MC twins was more likely to occur between 34 and 37 weeks, averaging 34.87±2.42 gestational weeks. Additionally, both twins A and B in the MC group weighed less than those in the DC group (p\u0026lt;0.001). After adjustment for confounders, TBA\u0026gt;40 µmol/l (aOR=9.16, 95%CI:1.06, 30.93, p=0.029) was an independent risk factor for poor perinatal outcomes in MC twin pregnancies complicated by ICP, and TBIL\u0026gt;17.1 µmol/l (aOR=6.36, 95% CI: 1.63-24.92, p=0.008), AST\u0026gt;200 U/L (aOR=3.005, 95%CI: 1.32-6.87, p=0.009) and ALP\u0026gt;400 U/L (aOR=3.25, 95%CI: 1.12-9.45, p=0.031) were independent risk factors for adverse perinatal outcomes in DC twin pregnancies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions \u003c/strong\u003eOur results suggest that some liver function biochemical indicators can predict poor foetal outcomes in twin pregnancies complicated by ICP. More focus is needed on the monitoring of predelivery liver functional biochemical indexes in pregnant women according to chorionicity complicated by ICP, to facilitate personalized antenatal management and improve neonatal outcomes.\u003c/p\u003e","manuscriptTitle":"Perinatal Outcomes of Monochorionic and Dichorionic Twin Pregnancies Complicated by Intrahepatic Cholestasis of Pregnancy: A 6-year Retrospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-13 19:48:47","doi":"10.21203/rs.3.rs-3926092/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-02T08:26:07+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-28T15:27:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-12T10:00:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"201602212944442822894198453674727409035","date":"2024-06-05T21:39:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"282334643718801152219701342970957075179","date":"2024-06-01T07:17:48+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-04-01T19:02:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-26T20:43:31+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-02-15T15:33:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-02-12T07:36:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-02-04T03:30:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1bcdb795-5d68-4ed1-b88f-ccf3f4fde0e3","owner":[],"postedDate":"February 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":28706306,"name":"Health sciences/Risk factors"},{"id":28706307,"name":"Health sciences/Medical research/Outcomes research"},{"id":28706308,"name":"Health sciences/Health care/Disease prevention"},{"id":28706309,"name":"Health sciences/Health care/Prognosis"},{"id":28706310,"name":"Health sciences/Signs and symptoms/Comorbidities"}],"tags":[],"updatedAt":"2025-08-07T07:12:51+00:00","versionOfRecord":{"articleIdentity":"rs-3926092","link":"https://doi.org/10.1038/s41598-025-09792-4","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-07-17 16:05:10","publishedOnDateReadable":"July 17th, 2025"},"versionCreatedAt":"2024-02-13 19:48:47","video":"","vorDoi":"10.1038/s41598-025-09792-4","vorDoiUrl":"https://doi.org/10.1038/s41598-025-09792-4","workflowStages":[]},"version":"v1","identity":"rs-3926092","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3926092","identity":"rs-3926092","version":["v1"]},"buildId":"zQwnuV7TCBrMSSSToR1PI","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}