Abstract

ObjectiveTo evaluate enzymatic total serum bile acid quantification as a monitoring strategy for women with intrahepatic cholestasis of pregnancy (ICP) treated with ursodeoxycholic acid (UDCA).DesignCohort.SettingOne UK university hospital.Population29 ICP cases treated with UDCA.MethodsSerial samples were collected prospectively throughout gestation. Total serum bile acids were measured enzymatically and individual bile acids by high‐performance liquid chromatography‐tandem mass spectrometry. Data were log‐transformed and analysed with random effects generalised least square regression.Main outcome measuresThe relationship between enzymatic total bile acid measurements and individual bile acid concentrations after UDCA treatment.ResultsIn untreated women, cholic acid was the principal bile acid (51%) and UDCA concentrations were <0.5%, whereas UDCA constituted 60% (IQR 43–69) of serum bile acids following treatment and cholic acid fell to <20%. Changes in the total bile acid measurement reflected similar alterations in the concentrations of the pathologically elevated bile acids, e.g. a two‐fold increase in enzymatic total bile acids is accompanied by approximately a two‐fold increase in cholic acid and chenodeoxycholic acid at most UDCA doses (P < 0.001). Most of the effects of UDCA on cholic acid occur in the first week of treatment (60% relative reduction, P = 0.025, 95% CI 0.2–0.9, from 10 micromol/l (4.7–17.6) to 3.5 micromol/l (1.4–7.5).ConclusionUrsodeoxycholic acid becomes the main component of the bile acid measurement after treatment. Enzymatic total bile acid assays are good predictors of both cholic acid and chenodeoxycholic acid, the primary bile acids that are raised prior to treatment.Tweetable abstractUrsodeoxycholic acid constitutes approximately 60% of the bile acid measurement and reduces pathological cholic acid in treated women.

Highlights

  • Intrahepatic cholestasis of pregnancy (ICP) is a liver disease characterised by pruritus and abnormal liver function[1,2] that affects approximately 0.7% of pregnancies

  • ICP monitoring with enzymatic assays during UDCA treatment proportion of each individual bile acid (BA) was compared in serum samples collected before and after UDCA commencement

  • The proportion of cholic acid (CA) in serum decreased to 42% of the pretreatment value following UDCA treatment, with the median falling from 51% to 19%

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Summary

Introduction

Intrahepatic cholestasis of pregnancy (ICP) is a liver disease characterised by pruritus and abnormal liver function[1,2] that affects approximately 0.7% of pregnancies. Intrahepatic cholestasis of pregnancy is a relatively benign condition for the mother, as it typically resolves rapidly after delivery.[1]. ICP is associated with a 2019 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

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