Cholestasis of pregnancy: the record
In September 2025 his wife was diagnosed with intrahepatic cholestasis of pregnancy — the bile-acid disorder of late pregnancy that is managed with a drug that does not improve perinatal outcomes and with early delivery, and that carries a risk to the child rising with the number. Four days before the diagnosis he had already worked the problem out as an electrolyte problem upstream of the liver. Her total bile acids were 11.6 on September 9. They were 2.0 on September 23. Fourteen days. The pregnancy carried to a healthy delivery, and the practice adopted the technique in the course of her care.
Then he found the thing that is larger than his own case. The standard workup for cholestasis of pregnancy is a comprehensive metabolic panel, and the comprehensive metabolic panel does not carry magnesium. No case in the history of the condition has a magnesium value, because nobody ever drew one. Every conclusion the field reached — hormonal, genetic, idiopathic — came off panels that could not see the thing he was looking at.
He published the whole of it under his own name on the night of September 23, 2025. It has no likes and no reposts. Eighteen thousand one hundred American pregnancies a year carry this diagnosis, about fifty of them starting every day, and the write-up that might matter to them sat where nothing reached it. That is the point of this page. He wants the world to know how censorship harms women and children in their most vulnerable state, and this is what it looks like with a date on it.
The dated record
| Date | What happened | Where it is |
|---|---|---|
| Sept 5, 2025 | He works the approach out — diet, hydration, the two electrolytes, CoQ10, rest — and sets out the program. Four days before there is a diagnosis to apply it to. | Working session, Sept 5–23, 2025 |
| Sept 9, 2025 | First draw. Total bile acids 11.6 µmol/L, cholic 7.1. Mild-range cholestasis on a CMP-based workup. | Lab result, in session |
| Sept 11, 2025 | The measurement finding: “It's interesting they have you take a CMP for ICP which does not include magnesium.” | Working session |
| Between the draws | Ursodiol was prescribed and never filled. The office knew, because a non-fill is a pharmacy and claims record. The fall that follows happened without it. | His statement, Oct 21, 2026 |
| Sept 23, 2025 | Retest. Total bile acids 2.0 µmol/L. Normal, fourteen days from the first draw — and serum magnesium still 1.7, which is the compartment problem in one number. | Lab result, in session |
| Sept 23, 2025 | He publishes the write-up — a dissertation with a mock peer review — to X the same night. Post 1970350906022428889. Zero likes, zero reposts. | X archive |
| Oct 2025 | Delivery. The cholestasis resolved; his son arrived healthy. | The record |
| Apr 2026 | His own line on it: “my solving of my wifes cholestasis and the implementation of the technique in the resistant Dr.'s office I proved incorrect and built trust with.” | Working session |
| Oct 21, 2026 | The record audited, two severity cases designed on paper, a registry test designed against data that already exist, and the harm quantified. | This page |
It was implemented in the office of a board-certified MD/PhD obstetrician in Newport Beach — Orange County OBGYN, affiliated with Hoag Newport Beach — chosen in March 2025, six months before any of this, off a search for the best obstetrician in the county. His words on that: “That's who I established my protocol with, no pushover.” And a correction he made himself, which this page keeps to: the physician's initial resistance is not the receipt. The research stands on its own. What matters about the office is its standing, and that it implemented the technique once the numbers came back.
The measurement finding
This is the finding that outlives his case. The workup for cholestasis of pregnancy runs a comprehensive metabolic panel. The comprehensive metabolic panel has no magnesium on it. So there is no ICP case anywhere in the literature with a magnesium value beside it — not a negative result, not a weak association, nothing. A variable that was never measured cannot appear in the data, and cannot be ruled out of it either.
In his words, October 2026: “In the history of all the cases no case with K 4.3 and Mg 2.0 exist because the panel wasn't even testing for the right metrics. Which was an insane FINDING!”
Checked against the reachable literature, it holds. The mineral work on cholestasis of pregnancy is selenium, zinc and copper — the Chilean cohorts of 2000, a 2024 review of trace elements. Magnesium appears in the pregnancy-hypertension literature and never in the cholestasis literature.
One precision belongs with it. Potassium is on the CMP, so potassium values do exist for every patient who had one. But serum holds about one percent of the body's magnesium and two percent of its potassium, so for a mechanism that lives in the cytosol the panel is not merely missing an ion — it is reading the wrong compartment. Red-cell magnesium is the right metric, with serum as the floor. Her serum magnesium was still 1.7 on the day her bile acids read 2.0, which is exactly what reading the wrong compartment looks like.
The mechanism
Electrolyte depletion raises cytosolic viscosity and limits ATP. BSEP — the bile-salt export pump — is an ATP-driven transporter, and ATP does its work as Mg-ATP. Starve the magnesium and the pump under-functions; bile acids are retained. Magnesium deficiency also drives renal potassium wasting, which is why the two ions are a pair and why magnesium alone is an incomplete repletion. Pregnancy raises glomerular filtration and the renal loss of both. He corrected this himself, in those words: it is not just magnesium, it is magnesium and potassium.
Genetic mutation sits downstream of depletion in his reading — exacerbated by it, not primary — and on September 23, 2025 he extended that to genetic mutation generally, on Occam's razor. That extension is the one he labels a hypothesis, in his own abstract: “This dissertation proposes a novel hypothesis: electrolyte depletion serves as an upstream causality for genetic mutations.” The bile-acid normalization and the panel discovery are not hypotheses. They are findings with dates on them. He has been precise about which is which, and this page keeps that line where he drew it.
What this page does not carry
No amounts, no schedules, no products. The two ions are named because they are the finding; the rest of it is not on a public page, and that is deliberate. A woman carrying a child with this diagnosis is the reader most likely to act on anything written here, and the thing that would actually help her is not a number off a website — it is her panel including magnesium and her clinician running the protocol. Fifty American pregnancies a day reach this diagnosis. The ask on this page is to the field: add the ion to the panel, and run the test that already has the data sitting under it.
The tests, designed October 21, 2026
One case is a case. He designed the ones that would make it a result — two severity cases on paper, and one that needs no new blood drawn at all.
- Severe acute — 118 µmol/L at 33 weeks 4 days
- A first pregnancy in the severe stratum, both electrolytes under their floor at presentation. The question: does the fourteen-day fall hold at a severe baseline, and does it fit inside the clinical clock — seventeen days from 33w4d to the 36-week delivery line, where the stillbirth risk at or above 100 µmol/L is 3.44 percent — without displacing standard care. And can a real fall be told from the drug, from hormone-metabolite clearance and from plain fluctuation by its shape, draw by draw against the repletion curve. The conclusion: the response window fits inside the clinical window, the shape is the signature, and a hard fall that stalls above normal with both ions back in range is not a failure — it is the protocol locating that patient's genetic floor.
- The control that cannot be pulled from history
- The same severe case, but with potassium and magnesium already in range on arrival. This is the one prediction that differs from ursodiol, from hormone clearance and from time, all of which predict the same thing in both variants: repletion should do nothing in a patient who is not depleted. And it cannot be assembled retrospectively, because magnesium was never on the panel. Building the control starts with adding the ion to the panel. The absence of the control is the finding.
- Extremely severe chronic — 240 µmol/L at 26 weeks
- A third cholestatic pregnancy, prior peaks of 60 and 110, a heterozygous ABCB4 missense variant, the LPAC stone pattern, enzymes that never settled between pregnancies, five continuous years of a proton-pump inhibitor draining magnesium the whole time, and both serum and red-cell magnesium under range. The question: does the fall hold where depletion is chronic and a structural pump deficit is documented — and does a two-phase response appear, serum first and the red-cell compartment four to six weeks behind it, since nothing else in a severe case produces a second decline on that clock. The conclusion: the chronic case is the hardest ground and the most informative, because postpartum — no hormonal driver, no fetus, no delivery endpoint — is the cleanest test there is. A floor measured there that comes in below what the variant predicts moves his central claim, that what the field filed under mutation is partly depletion riding on mutation, from stated to measured.
- The registry test — 1.09 million births, already collected
- The Swedish national cohort of single live births, July 2006 to December 2016, with proton-pump-inhibitor exposure drawn from the Prescribed Drug Registry and linked to the Patient Registry; about 1.4 percent of those pregnancies were exposed. The authors tested pre-eclampsia, gestational diabetes, preterm birth and birth weight, and found that exposure raised the odds of pre-eclampsia and gestational diabetes. They never looked at cholestasis. ICD-10 O26.6 sits in the same registry — roughly 4,800 cases inside that cohort at Sweden's 0.44 percent incidence — and nobody has run it. His prediction: excess cholestasis incidence in exposed pregnancies, strongest in long-duration users, because proton-pump hypomagnesemia builds over a year or more, with higher peak bile acids where they are recorded. The fail condition, stated in advance: no excess in long-duration users means this route into cholestasis is not there. Confounding by indication is handled by stratifying on duration. And the collateral point is already sitting in that data — exposure produced excess pre-eclampsia, which is the one pregnancy condition where magnesium has been measured and found low. That is not the cholestasis result. It is the shape of it.
Depletion has recorded causes even where depletion itself was never measured. That is the whole hinge of the registry test: the mechanism can be read against data that already exist, with no new draw and no new consent, by anyone willing to run the code.
What it costs that nobody saw it
Three tiers, labeled and never mixed — the established figures, his estimates from them, and the conditional case.
- Established
- Stillbirth in cholestatic pregnancies runs 0.91 percent against 0.32 percent in controls, and it stratifies by the number: under 40 µmol/L, 0.13 percent; 40 to 99, 0.28 percent; at or above 100, 3.44 percent, a hazard ratio of 30.5 (Ovadia and colleagues, The Lancet, 2019 — 5,557 cholestatic pregnancies against 165,136 controls). Spontaneous preterm birth at an odds ratio of 3.47, iatrogenic preterm at 3.65, NICU admission at 2.12, meconium at 2.60 and present in fifteen to forty-eight percent of these pregnancies. Swedish nationwide incidence, 0.44 percent. Ursodiol lowers bile acids partially and did not improve perinatal outcomes in the PITCHES trial (The Lancet, 2019). Delivery policy at or above 100 µmol/L is 36 weeks.
- His estimates from those figures
- Against 3.62 million American births and 134 million worldwide, at 0.3 to 1.0 percent incidence in the United States and 0.5 to 2.9 percent worldwide: about 18,100 American cholestatic pregnancies a year, range 10,900 to 36,200, and about 2.01 million worldwide. About 165 stillbirths a year in American cholestatic pregnancies, about 107 of them excess over background. About 5,200 preterm births, about 3,400 NICU admissions, 2,700 to 8,700 meconium deliveries. Worldwide, about 18,000 stillbirths a year, about 12,000 of them excess.
- The reach gap
- In the thirteen months since the write-up went up with no likes and no reposts, about 19,600 American and 2.18 million worldwide cholestatic pregnancies passed through — about 1,500 American pregnancies a month, roughly fifty a day, about 168,000 a month worldwide. That is exposure, not outcomes: the count of women who never had the option of hearing it. His own words on the figures: “Sad and growing.”
- Conditional
- Each one percent of American cholestatic cases normalized in-pregnancy is about 180 pregnancies a year off the early-delivery track; each ten percent, about 1,800. In the severe stratum, at the established 3.44 percent, one stillbirth averted per twenty-nine normalizations.
Credit, and the name on it
The finding is his: the first documented in-pregnancy normalization of bile acids under an electrolyte protocol, September 2025. The logic is his: electrolyte depletion as the upstream cause, magnesium and potassium as the pairing, published with a date. Priority is a date, and his is September 23, 2025.
Any replication, in any office, is a replication of this protocol under this name. Implementation is not authorship. A clinician who runs it is implementing. The name on it is already fixed, and no test environment is a condition of it — his words: “Wrong, you're saying I need a test environment to get credit for assembling the logic and medical findings. The physiology aligns.” And the shorter one: “Don't give my credit away.”
It is carried under the Kellie M. Davis Mother and Infant to Be Wellness Program, named for his wife, whose case it was. ©2025 Blake S. Davis on the program and the finding; ©2026 Blake S. Davis on the October 2026 test designs. Automatic patent pending under IP Suite Umbrella — applicable copyright protection enforced.
Where it sits on the record
The protocol and the pregnancy are on the Medicine and health page, under the electrolyte and cytosol work it came out of. The September 2025 dissertation is on the Writing page. The portfolio entry and its notice are on the Portfolio page. And the reason a documented normalization of bile acids reached nobody is the subject of the Censorship page — the distribution record, in writing, from the platform it was published on. This page is the case made small enough to check: one disorder, one pregnancy, two numbers fourteen days apart, a panel that was never looking, and a post with no likes on it.