ArticlePakistan journal of medical sciences2026
The mind-liver connection: Exploring psychological stress and its association with the risk of developing intrahepatic cholestasis of pregnancy.
Article in Pakistan journal of medical sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objectives: To determine the association between intrahepatic cholestasis of pregnancy (ICP) and psychological distress (depression, anxiety, and stress measured using the DASS-21) among Pakistani pregnant women during the second and third trimesters. Methodology: A prospective observational study was conducted from August 2024 to August 2025 at the Department of Physiology, Islamic International Medical College, jointly with Holy Family Hospital, Rawalpindi and Prime Lab Diagnostics. A total of 140 pregnant women, of ages between 20-40 years, were enrolled after taking informed consent. The DASS-21 questionnaire (Depression, Anxiety and Stress Scale - 21 items) was used in the second trimester and repeated in the third trimester to measure depression, anxiety and stress levels. ICP symptoms such as nocturnal itching were observed throughout pregnancy. Liver function and serum bile acids tests were performed in both second and third trimesters to ascertain the diagnosis. Later, the participants were divided into ICP and non-ICP groups. DASS-21 scores were compared between the two groups. Results: Depression, anxiety, and stress scores were significantly higher in the ICP group during the third trimester (p < 0.01). Wilcoxon signed-rank tests revealed a prominent rise in depression and stress from the second to third trimester within the ICP group. Mann-Whitney U tests showed depression, anxiety, and stress were higher in the ICP group, particularly in the third trimester (all p < 0.05). Logistic regression identified third-trimester depression (OR: 1.34, p = 0.005) and stress (OR: 1.17, p = 0.026) as significant predictors of ICP. Model fit was acceptable (Hosmer-Lemeshow p = 0.174; AUC = 0.796). Conclusion: Third-trimester psychological stress, particularly depression and stress symptoms, is associated with ICP. Routine antenatal screening may help identify women at risk for timely intervention.
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