Abstract
Objective: To explore the association of poor sleep quality with the development of intrahepatic cholestasis of pregnancy (ICP).
Methodology: This prospective cohort study was conducted at Islamic International Medical college in collaboration with Rawalpindi Medical University. We enrolled 182 pregnant women between the ages of 20-40 years, from Railway Hospital and Holy Family Hospital, in their second trimester. Sleep quality was determined using Pittsburgh Sleep Quality Index (PSQI). The participants were divided into two groups: Group I, n = 113 (good sleep quality), and Group II, n=69 (poor sleep quality). Blood samples were withdrawn for Alanine transaminase (ALT), Aspartate transaminase (AST), Alkaline phosphatase (ALP), bilirubin and fasting Total bile acids (TBA) to establish their baseline values. During their third trimester (between 28th to 36th week), same tests were repeated. History of pruritus, a main symptom of ICP was also explored. Differences between continuous and categorical variables among two groups were evaluated using the Mann-Whitney U test and Chi-square test, respectively. Regression analysis was also employed.
Results: Significant differences in liver enzymes and TBA were found between the two groups (p<0.001). A significant correlation of sleep score with ALT, AST, ALP, TBA and age (p<0.05) was found. Significantly higher proportion of participants who developed disease in the third trimester were in group II as compared to group I (p=0.000). Logistic regression analysis showed that poor sleep quality was an independent risk factor for the development of ICP (OR:1.410, p=0.01).
Conclusion: The study concluded that poor sleep quality is an independent risk factor for the development of ICP in pregnancy.

Key words: Alanine transaminase, Alkaline phosphatase, intrahepatic cholestasis of pregnancy, sleep quality, total bile acids.