Recurrent jaundice in pregnancy: II. A study of the estrogens and their conjugation in late pregnancy

Abstract

The excretion of estrogens in the urine of patients with recurrent jaundice of pregnancy was compared with that of normal pregnant women in the last trimester of pregnancy. In one of the patients with jaundice three estimations in bile and one in blood were carried out and compared with the results in normal subjects. The following estrogens were assayed: estrone, estradiol-17β, estriol, estrone-sulfate, 17β-estradiol-3-sulfate and estriol-3-sulfate. In addition, the conjugation pattern of the estrogens was investigated by dividing the conjugates into two groups by gel filtration (peak I and peak II according to the method of Beling). The present investigation indicates that the urinary excretion of estrone, estradiol-17β and estriol in patients with recurrent jaundice of pregnancy is normal during the icteric phase of the disease. However, significantly smaller amounts of 17β-estradiol-3-sulfate were found in all patients with jaundice and the proportion of estriol-3-sulfate was significantly higher. In addition, it was found that in these patients there was a shift from peak I conjugates to peak II conjugates following gel filtration of the urine samples and that the peak II conjugates contained significantly more of one or several unknown polar estrogens other than estriol. It is concluded that the significant changes in estrogen metabolism found are more likely to be chiefly secondary to the jaundice and impaired enterohepatic circulation of the estrogens than a primary defect bearing a causal relationship to the liver disease.