Abstract
Until now, biochemical parameter for diagnosis of intrahepatic cholestasis of pregnancy (ICP) mostly used is the rise of total serum bile acids (TSBA) above the upper normal limit of 11 μM. However, differential diagnosis is very difficult since overlapped values calculated on bile acids determinations, are observed in different conditions of pregnancy including the benign condition of pruritus gravidarum. The aim of this work was to determine the better markers in ICP for a precise diagnosis together with parameters associated with severity of symptoms and treatment evaluation. Serum bile acid profiles were evaluated using capillary electrophoresis in 38 healthy pregnant women and 32 ICP patients and it was calculated the sensitivity, specificity, accuracy, predictive values and the relationships of certain individual bile acids in pregnant women in order to replace TSBA determinations. The evaluation of the results shows that LCA and UDCA/LCA ratio provided information for a more complete and accurate diagnosis and evaluation of ICP than calculation of solely TSBA levels in pregnant women.
Highlights
Intrahepatic cholestasis of pregnancy (ICP) is a pregnancyspeci c liver disease and it takes place in the second or third trimester of gestation and it spontaneously disappears a er delivery [1, 2].intrahepatic cholestasis of pregnancy (ICP) is characterized by generalized skin pruritus and abnormal liver function, and it is associated with increased fetal distress, premature deliveries, and perinatal mortality and morbidity. erefore, an early and accurate diagnosis of a risky pregnancy produced by ICP is essential [3,4,5].Usually, diagnosis of ICP is based on pruritus with mild or moderate elevated levels of amino transferases and/or raised total serum bile acids (TSBAs) [6]
Differential diagnosis is very difficult since overlapped values calculated on bile acids determinations, are observed in different conditions of pregnancy including the benign condition of pruritus gravidarum. e aim of this work was to determine the better markers in ICP for a precise diagnosis together with parameters associated with severity of symptoms and treatment evaluation
Serum bile acid pro les were evaluated using capillary electrophoresis in 38 healthy pregnant women and 32 ICP patients and it was calculated the sensitivity, speci city, accuracy, predictive values and the relationships of certain individual bile acids in pregnant women in order to replace TSBA determinations. e evaluation of the results shows that lithocholic acid (LCA) and ursodeoxycholic acid (UDCA)/LCA ratio provided information for a more complete and accurate diagnosis and evaluation of ICP than calculation of solely TSBA levels in pregnant women
Summary
Intrahepatic cholestasis of pregnancy (ICP) is a pregnancyspeci c liver disease and it takes place in the second or third trimester of gestation and it spontaneously disappears a er delivery [1, 2]. A subgroup of asymptomatic pregnant women with high levels of TSBA, and normal liver function tests but not showing pruritus, has recently been classi ed as asymptomatic hypercholanemia of pregnancy (AHP) [7,8,9,10]. Several reports have demonstrated that different ratios calculated from individual bile acid determinations are useful in the comprehension of different types of liver diseases [2, 12,13,14]. Taking into account the need for better markers for the precise diagnosis of ICP and the search of parameters associated with severity of symptoms and treatment efficiency, we determined the sensitivity, speci city, accuracy, predictive values, and the relationships of certain individual bile acids in pregnant women to replace TSBA determinations
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