Relation of climatic exposures with intrahepatic cholestasis of pregnancy in a two-center retrospective cohort.

Authors

Xiao Chen, Chang Zou, Yang Liu, Ruru Zhao, Hanxiang Sun, Xiaosong Liu, Qinxin Shen, Yuanyuan Yang, Qiaoling Du

Published in

Frontiers in endocrinology. Volume 17. Pages 1924211. Epub Aug 14, 2026.

Abstract

To investigate relation between climatic exposures and intrahepatic cholestasis of pregnancy (ICP) in Chinese cities Shanghai and Sanya.
ICP is a pregnancy-specific liver disease associated with adverse fetal outcomes. Although the etiology of ICP remains unclear, climatic exposures are increasingly recognized as one of the critical correlates in ICP onset.
This is a two-center retrospective cohort study included 48, 081 pregnant women from Shanghai (31°N, temperate) and Sanya (18°N, tropical). Baseline demographic data, pregnancy outcomes and meteorological data were collected. Generalized additive models (GAMs) were employed to analyze non-linear associations between environmental exposures and ICP risk, with statistical comparisons of baseline characteristics and complications between ICP and non-ICP groups.
GAM analysis revealed that temperature, sunlight and PM_2.5 exhibited positive gestation-age-dependent non-linear correlations with ICP risk in Shanghai, while relative humidity showed an inverse correlation. No meteorological exposures showed significant associations with ICP in Sanya. Sunlight could amplify heat-related exposure signals alongside high temperature. In Shanghai, pregnancies conceived in February and March showed the highest ICP incidence, while Sanya showed no significant seasonal fluctuation and maintained a higher overall ICP incidence than Shanghai under constant warm climate. Thalassemia prevalence was higher in ICP cases compared to controls in both regions (Sanya: 31.8% vs. 17.9%; Shanghai:1.0% vs. 0.4%, all P<0.05). ICP patients in both cohorts demonstrated shortened gestational age, with Shanghai exhibiting a more pronounced gestational age reduction correlated with higher cesarean delivery rates.
High temperature, intense sunlight exposure, and high PM_2.5 concentration across preconception and mid-pregnancy serves as major climatic correlates of ICP incidence.

PMID:
42666169
Bibliographic data and abstract were imported from PubMed on 29 Aug 2026.

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