Recent study explored the relationship between bile acid levels in intrahepatic cholestasis of pregnancy (ICP) and adverse pregnancy outcomes in twin pregnancies. ICP is characterized by maternal pruritus and elevated serum bile acids, with a prevalence of 0.3-15% worldwide. The research aimed to investigate the impact of bile acid levels on adverse outcomes like preterm birth and stillbirth in twin pregnancies. Elevated bile acid levels can lead to ICP, affecting maternal and fetal health. Data Analysis and Results The study analyzed data from 1156 patients with twin pregnancies and ICP. Results showed differences in gestational age at ICP diagnosis, TBA levels, delivery age, and preterm birth rates among the groups. Peak TBA levels were categorized as mild, moderate-low, moderate-high, and severe to assess ICP severity. Adverse outcomes included gestational diabetes, preeclampsia, placental abruption, premature rupture of membranes, fetal distress, and stillbirth. There were significant variations in neonatal birth weight, incidence of low birth weight, and meconium-stained amniotic fluid among groups. Associations with Complications Intrauterine fetal death cases were identified, with a 1.82% rate, most occurring within a month of ICP diagnosis. Higher TBA levels were associated with an increased risk of fetal complications like preterm birth, fetal distress, and meconium-stained amniotic fluid. The study found no significant maternal-fetal complications among the groups. Stillbirth rates varied across different gestational ages, suggesting the need for enhanced fetal monitoring, especially in the late stages of pregnancy. ICP Severity and Preterm Birth Risk ICP severity significantly correlated with preterm birth, with increasing bile acid levels raising the risk of preterm birth. The study highlighted the importance of timely pregnancy termination in twin pregnancies with ICP to reduce adverse outcomes. Future research with larger cohorts is vital to understand the link between bile acid levels and twin pregnancy prognosis, aiding clinicians in making informed decisions and enhancing management strategies for ICP during twin pregnancies. Study Conclusion In conclusion, the study underlines the impact of bile acid levels on adverse pregnancy outcomes in twin pregnancies complicated by ICP. It emphasizes the necessity for further research to optimize clinical management strategies for ICP in twin pregnancies, ultimately improving maternal and fetal health outcomes. - The study focused on investigating the correlation between bile acid levels in intrahepatic cholestasis of pregnancy (ICP) and adverse pregnancy outcomes in twin pregnancies, noting the prevalence of ICP worldwide and its implications on maternal and fetal health. - Data analysis of 1156 patients with twin pregnancies and ICP revealed differences in gestational age at diagnosis, Total Bile Acid (TBA) levels, delivery age, and preterm birth rates among groups, with varying severity categories of ICP based on peak TBA levels. - Adverse outcomes such as gestational diabetes, preeclampsia, placental abruption, premature rupture of membranes, fetal distress, and stillbirth were noted, along with variations in neonatal birth weight, incidence of low birth weight, and meconium-stained amniotic fluid across groups. - Higher TBA levels were linked to increased risks of complications like preterm birth, fetal distress, and meconium-stained amniotic fluid, impacting fetal health significantly, while no significant maternal-fetal complications were found among groups. - ICP severity was found to be significantly correlated with preterm birth risk, suggesting the importance of timely pregnancy termination in twin pregnancies with ICP to mitigate adverse outcomes and highlighting the need for enhanced fetal monitoring in late pregnancy stages. - The study concluded by stressing the importance of further research in understanding the relationship between bile acid levels and twin pregnancy prognosis in ICP, aiming to improve clinical management and outcomes for maternal and fetal health in twin pregnancies affected by ICP. Reference – Yongzhao Zhao et al. (2025). Preterm Birth And Stillbirth: Total Bile Acid Levels In Intrahepatic Cholestasis Of Pregnancy And Outcomes Of Twin Pregnancies: A Retrospective Cohort Study From 2014 To 2022. *BMC Pregnancy And Childbirth*, 25. https://doi.org/10.1186/s12884-025-07644-7.