Abstract
Intrahepatic cholestasis of pregnancy (ICP) is the most common hepatic disorder related to pregnancy in women. It usually develops within the third trimester of pregnancy and presents with pruritus as well as elevated levels of bile acid and/or alanine aminotransferase. Clinical signs quickly resolve after delivery; however, there is a high risk of the disorder recurring in subsequent pregnancies. ICP is associated with an increased risk of perinatal complications (premature birth, respiratory disorders, even stillbirth). Elevated levels of gestational hormones and genetic predispositions are important factors for the development of ICP; among the latter, mutations in hepatobiliary transport proteins (multidrug resistance protein 3-MDR3, bile salt export pump- BSEP) play a major role. Clinical and biochemical symptoms of ICP include pruritus and increased levels of total bile acids (TBA). Serum levels of TBA should be monitored in ICP patients throughout the pregnancy as concentrations above 40 μmol/L, which define that severe ICP isassociated with an increased risk of fetal complications. Therapeutic management is aimed at reducing the clinical symptoms, normalizing maternal biochemistry and preventing complications to the fetus. Pharmacological treatment of intrahepatic cholestasis of pregnancy consists of the administration of ursodeoxycholic acid to lower the levels of TBA and possibly reduce pruritus. If the treatment fails, premature delivery should be considered.
Highlights
During pregnancy, numerous physiological and anatomical changes occur in the female body so as to ensure the best possible conditions for fetal growth
Because most women with intrahepatic cholestasis of pregnancy (ICP) and singleton pregnancies have total bile acid (TBA) below this concentration, they can probably be reassured that the risk of stillbirth is similar to that of pregnant women in the general population, provided repeat bile acid testing is done until delivery
Ovadia et al found that for singleton pregnancies, the prevalence of stillbirth was three (0.13%) of 2310 intrahepatic cholestasis of pregnancy cases in women with serum total bile acids of less than 40 μmol/L versus four (0.28%) of 1412 cases with total bile acids of 40–99 μmol/L and versus 18 (3.44%) of 524 cases for bile acids of 100 μmol/L or more [24].Germain et al observed that bile acids increase the expression and sensitivity of oxytocin receptors in uterine muscles, potentially leading to increased rates of premature deliveries in ICP patients [25]
Summary
Numerous physiological and anatomical changes occur in the female body so as to ensure the best possible conditions for fetal growth. An increase in the circulating blood volume as well as changes in numerous hematological and biochemical markers are observed as altered functions of organs, which are reflected in laboratory test results. Increasing insulin resistance and hormonal changes lead to changes in the maternal lipid metabolism [2]. Another function of the liver altered in the course of pregnancy is the transport of bile and the associated progressive increase in the total bile acid (TBA) levels in blood. In most pregnancies, this increase is moderate, and the TBA levels remain within the reference range. Some mothers may experience an excessive increase in bile acid levels as a consequence of intrahepatic cholestasis of pregnancy (ICP) [3]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
